天津医科大学内科学课件 Mitral Regurgitation.pptVIP

?Valvular Heart Disease  Mitral Regurgitation Xin Du, MD Cardiovascular Centre Mitral Regurgitation (MR) -Etiology Alterations of the Leaflets, Commissures, Annulus Rheumatic MVP Endocarditis Alterations of LV or LA size and Function Papillary Muscle (Ischemic, MI, Myocarditis, DCM) HOCM LV Enlargement – Cardiomyopathies - LA Enlargement from MR – MR begets MR MR -Pathophysiology In systolic period, blood flow from LV → LA, LA filling pressure↑ In diastolic period, LV accepts more blood →LV volume overload, dilation, hypertrophy →LVEDP↑ →LAP↑→PCWP↑→PAP↑→RHF, CO↓ MR -Pathophysiology Acute MR Normal (noncompliant) LA Increase LA pressure large “V” waves Acute Pulmonary Edema Chronic MR Dilated, compliant LA LA pressure normal or slightly increased Fatigue, low output state Atrial arrhythmias- a. fib. Most patients fall between these two extremes!! MR -Clinical Presentation Symptoms: Asymptomatic ( gradually, 20 years), palpitation, fatigue and weakness, dyspnea, pulmonary edema, right sided HF, MVP (Mitral Valve Prolapse) Syndrome (if present) Signs: Holosystolic Apical Blowing Murmur Laterally displaced apical impulse Split S2 (but is obscured by the murmur) S3 Gallop (increased volume during diastole) Radiation depends on the etiology MR -Clinical Presentation Laboratory Examinations Electrocardiography: LA enlargement, Af, LV hypertrophy X- Ray: Chronic– cardiomegaly (LV, LA) Acute– interstitial edema (Kerley B) Echocardiography: M-mode, 2-D, Color, Doppler, Real-time 3D Angiocardiography MRI Echocardiography MR P2 PLP Chordae Rupture MR -Medical Management Low sodium diet Preload reduction Diuretics Afterload reduction Vasodilators Nitroprusside [generic] ACE inhibitors Hydralazine [generic] Digoxin [generic] Subacute bacterial endocarditis(SBE) prophylaxis Tricuspid Valve Endocarditis – IV drug abusers or inpt with IVs Carcinoid HD - classically TS TR – common, benign, may