Valvular heart disease瓣膜性心脏疾病

Nocturnal palpitation&PND（夜间阵发性呼吸困难）
Pedal edema
Mitral Stenosis: Etiology
Primarily a result of rheumatic fever Scarring & fusion of valve apparatus &Degenerative (calcification) Rarely congenital Pure or predominant MS occurs in approximately 40% of all patients with rheumatic heart disease Two-thirds of all patients with MS are female.
X-ray film
Mitral Stenosis: Role of Echocardiography
Diagnosis of Mitral Stenosis Assessment of hemodynamic severity mean gradient, mitral valve area, pulmonary artery pressure Assessment of right ventricular size and function. Assessment of valve morphology to determine suitability for percutaneous mitral balloon valvuloplasty Diagnosis and assessment of concomitant valvular lesions Reevaluation of patients with known MS with changing symptoms or signs. F/U of asymptomatic patients with mod-severe MS
Recognizing Mitral Stenosis
Palpation:
Small volume pulse
Tapping apex-palpable S1 +/- palpable opening snap (OS) RV lift Palpable S2
Auscultation:
Mitral Stenosis: Symptoms
Fatigue
Palpitations
Cough Left sided failure Orthopnea PND

Afib Systemic embolism Pulmonary infection Hemoptysis Right sided failure
Hepatic Congestion Edema
Palpitation
hoarseness (ortner’s syndrome)
Worsened by conditions that cardiac output.
Exertion,fever, anemia, tachycardia, Afib, intercourse, pregnancy, thyrotoxicosis
Two-dimensional
Doppler
Mitral Stenosis: EKG
LAE RVH
Premature contractions
Atrial flutter and/or fibrillation
freq. in pts with mod-severe MS for several years
Common Murmurs and Timing
Systolic Murmurs Aortic stenosis Mitral insufficiency Mitral valve prolapse Tricuspid insufficiency Diastolic Murmurs Aortic insufficiency Mitral stenosis
Usually there are no symptoms until the valve orifice is moderately stenosed (i.e. has an area of 1.5cm2). Because of pulmonary venous hypertension and recurrent bronchitis, progressively severe dyspnoea develops. A cough productive of blood-tinged, frothy sputum and occasionally frank haemoptysis may occur. Right heart failure and its symptoms of weakness, fatigue and abdominal or lower limb oedema. Atrial fibrillation, giving rise to palpitations. Atrial fibrillation may result in systemic emboli.
A fib develops in 30% to 40% of pts w/symptoms

A 75 year old woman with loud first heart sound and mid-diastolic murmer
Mitral Stenosis
ECG
Mitral Stenosis
Mitral Stenosis
A 75 year old woman with loud first heart sound and mid-diastolic murmur
Chronic dyspnea Class II/VI Fatigue
Recent orthopnea(端坐呼吸)
Loud S1- as loud as S2 in aortic area
A2 to OS interval inversely proportional to severity Diastolic rumble: length proportional to severity In severe MS with low flowS1, OS & rumble may be inaudible
Rheumatic Heart Disease, cont.
Subjective symptoms
Prior history of rheumatic fever General malaise Pain – may or may not be present
Objective symptoms
Rheumatic Heart Disease
Inflammatory process that may affect the myocardium, pericardium and or endocardium Usually results in distortion and scarring of the valves
ECG:
LAE, AFIB, RVH, RAD
Mitral Stenosis: Physical Exam
S1
S2 OS
S1
First heart sound (S1) is accentuated and snapping Opening snap (OS) after aortic valve closure Low pitch diastolic rumble at the apex Pre-systolic accentuation (esp. if in sinus rhythm)
心脏瓣膜病
The First Affiliated Hospital of Guangzhou Medical University Department of Cardiovascular Chen ailan(陈 爱兰)
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
Mitral Stenosis:Pathophysiology
Normal valve area: 4-6 cm2 Mild mitral stenosis:
MVA 1.5-2.5 cm2 Minimal symptoms
Mod mitral stenosis
MVA 1.0-1.5 cm2 usually does not produce symptoms at rest
Explain treatment and home care
What Are the Types of Valve Disease?
There are several types of valvular heart disease, include: 1)Valvular stenosis: When a valve opening is smaller than normal 2)Valvular Insufficiency/REGURGITATION: occurs when a valve does not close tightly, thus allowing blood to leak backwards.