Download VALVULAR HEART DISEASE

VALVULAR HEART DISEASE
Shen Jieyan MD
SSMU
Department of cardiology
Rheumatic Fever
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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: exuduation, proliferation
(Aschoff nodes), scarring
Rheumatic Fever
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Clinical Manifestations:
fever, rheumatic carditis, arthritis, chorea,
deformity of skin
Laboratory finding:
ASO>500U, ASK>80U, ESR↑,Alb↓,γ+a2↑
CRP(+),
CPK-MB↑, GOT↑,TnT TnI↑, C3↑, IgA↑
Rheumatic Fever
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Diagnosis: Jones standards, 1992 AHA
Treatment:
1) rest
2) antibiotics :Penicillin
3) anti- inflammation: Aspirin
Corticosteroids
4) others
Prevention
Mitral Stenosis
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Etiology:
predominant cause: rheumatic fever
rare cause
Pathology:
thickening, shortening, adhering, calcium
depositing, and scarring
four forms of fusion: (1) commissural, (2)
cuspal, (3)chordal, (4)combined
two types of shape: fish-mouth shaped, funnelshaped
Mitral Stenosis
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Pathophysiology:
normal cross-sectional area:4-6 cm2
mild MS: <2 cm2, LAP↑→LAH
---compensated period
moderate MS: <1.5 cm2, PVP↑, PCWP↑,
→interstitial edema
severe MS: <1.0 cm2,PAP↑→RVoverload
→RV failure →TR →PR
Mitral Stenosis
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Clinical Manifestations (MVA<1.5cm2)
1. Symptom: dyspnea, hemoptysis, cough,
hoarseness (ortner’s syndrome)
2. Signs:
-Mitral faces
-Diastolic thrill at apex
-S1↑(flexible), OS, Diastolic rumbling murmur
at apex,
-P2↑, splitting, Graham-Steel murmur(PR),TR
Mitral Stenosis
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Laboratory Examination
- ECG:
1) left atrial enlargement: P wave (II,V1)
2) Af; 3) right ventricular hypertrophy
- X-film: change in cardiac silhouette,
Kerley B lines
- Echocardiography: M-mode, Twodimensional, 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
风湿性二尖瓣狭窄
Rheumatic mitral stenosis
风湿性二尖瓣狭窄
Rheumatic mitral stenosis
Mitral Stenosis
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Diagnosis & Differential diagnosis
- Diastolic rumbling murmur at apex
+ X-film + ECG + Echo
- relative MS; Austin-Flint murmur;
left atrial myxoma ; Graham steell murmur
Complication:
Atrial fibrillation; acute pulmonary edema;
congestive heart failure; thromboembolism;
infective endocarditis; pulmonary infective
Mitral Stenosis
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Management:
- Medical treatment:
Antibiotics, Diuretics and Digitalis,
Antiarrhythmic drugs, Anticoagulant
- Percutaneous balloon mitral valvuloplasty
( PBMV)
- Surgical treatment:
Closed mitral valvotomy
Open valvotomy
Mitral valve replacement
Mitral Regurgitation
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Etiology and Pathology
- Abnormalities of valve leaflets:
Rheumatic, infective
- Abnormalities of the mitral annulus:
dilatation, calcification
- Abnormalities of the chordae tendineae:
congenitally, infective, trauma, Rheumatic
- Involvement of papillary muscle: CAD
Mitral Regurgitation
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Pathophysiology
In systolic period, blood flow from LV →
LA, LA filling pressure↑;
in diastolic period, LV accepts more blood
→LV dilation, hypertrophy →LVEDP↑
→LAP↑→PCWP↑→PAP↑→RHF; CO↓
Chronic
Acute
Mitral Regurgitation
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Clinical Manifestations
(1) Symptoms: asymptomatic( gradually,>20 years),
palpitation, fatigue, dyspnea, pulmonary edema
(2) Signs:
- apical pulse→left,lower
- apical beat heavy
- cardiac dullness enlarged→left
- pansystolic murmur at apex, radiate to left
axilla, subscapular
- S1↓,P2↑
Mitral Regurgitation
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Laboratory Examination:
- ECG: 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 resonance
imaging
二尖瓣脱垂伴关闭不全
二尖瓣关闭不全
Mitral Regurgitation
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Diagnosis:
systolic murmur at apex + LA↑, LV↑+ Echo
Differential Diagnosis:
relative MR, ventricular septal defect,
tricuspid regurgitation, aortic stenosis
Management:
- Medical treatment
- Surgical treatment
Aortic Stenosis
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Etiology & Pathology:
- Rheumatic AS, Congenital AS,
Degenerative calcific AS
Pathophysiology:
- Obstruction to LVOT→ LVH→ LAH→ PVP↑→
Pulmonary edema;
- LVEF↓→ischemia of peripheral、brain、heart
Aortic Stenosis
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Clinical Manifestations:
- Symptoms: heart failure (fatigue, dyspnea),
angina pectoris, syncope, sudden death
- Signs: Apical impulse↑,to left
Systolic thrill in AV area,pulse↓
Cardiac dullness→left
Ejection sound & SM in AV area, radiate
to neck
A2↓ splitting paradoxically
Aortic Stenosis
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Laboratory Examination:
ECG; X- film;
Echocardiography; Angiography
Diagnosis & 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 stenosis and
regurgitation
Aortic Stenosis
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Complications:
Sudden death, heart failure, arrhythmia,
infective endocarditis, systemic embolism
Management:
- Medical treatment
- Surgical treatment
Aortic Regurgitation
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Etiology & Pathology
- Valvular Disease:
rheumatic, congenital, infective
prolapse, ankylosing spondylitis, degenerative
- Aortic Root Disease:
syphilitic aoritis, Marfan syndrome,
ankylosing spondylitis, degenerative
- Acute AR: infective, trauma, aortic dissection
Aortic Regurgitation
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Pathophysiology:
- LV receives both blood from LA & AO
→volume overload →LV dilation →
pulmonary edema →relative MI,MS;
- Diastolic pressure↓,pulse pressure↑
Aortic Regurgitation
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Clinical Manifestations:
- Symptom: palpitation, angina
- Sign: apical impulse→ left, inferior
cardiac dullness →left, inferior
Boot-shaped shadow—cardiac waist↓
DM in AV2 area →apex
S1↓,A2↓
relative MI—SM at apex
relative MS—Austin Flint
Aortic Regurgitation
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Sign: Peripheral vascular sign:
- pulse pressure↑, carotid pulsation↑
- Musset sign, water hammer pulse,
Traube sign, Duroziez murmur,
Muller sign, Quincke sign,
Laboratory Examination:
ECG, X-Film, Echo, etc
Aortic Regurgitation
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Diagnosis & Differential Diagnosis:
AI + peripheral vascular signs + Echo
Complication: infective endocarditis
ventricular arrthymia
heart failure
Aortic Regurgitation
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Management:
Medical treatment
Surgical treatment