西安交通大学医学院循环系统疾病课件 Valvular Heart Disease（2）.pptVIP

Valvular Heart Disease Definition 1. Acquired heart disease (1) rheumatic (2) calcification 2. Valvular disease (1) a group of heart disease (2) three kind lesions 3. Susceptible heart valve MitralAorticTricuspidPulmonary Mitral Stenosis Mitral Regurgitation Aortic Stenosis Aortic Regurgitation Mitral valve disease Mitral stenosis (MS) Etiology and Pathology Rheumatic heart disease Congenital malformation Senile mitral annulus and subvalvular calcification Etiology 1. MS is nearly always rheumatic 2. Approximately 25% of all patients with rheumatic heart disease have pure MS and additional 40% have combined MS and MR 3. Two-thirds of all patients with rheumatic MS are female 4. The duration from the acute rheumatic attack to the development of MS : 2-3 or 10-25 years Pathology Pathophysiology The cross-sectional area of the mitral valve ring Normal adults 2-2.5 cm diameter 4 - 6cm square Mild MS ≤2cm2 Moderate MS ≤1.5cm2 Severe MS ≤1.0cm2 Pathophysiology mitral stenosis if the valve orifice2 cm square LA enlargement and pressure elevated PV pressure elevation PA pressure elevation RV RA pressure elevation right heart failure —RA failure dyspnea RV failure—edema Clinical manifestation Clinical manifestation Diastolic rumble murmur in mitral stenosis Laboratory Examination X－Ray LA enlargement RV enlargement pulmonary Vein congestion ECG PⅡ0.12s (Mitral P wave) RV1↑(RV enlargement) Atrial fibrillation Echocardiogram---cornerstone of the diagnosis Diagnosis Symptoms Signs (DM) Some examines (echocardiography) Differential Diagnosis Complications Atrial fibrillation Acute pulmonary edema Embolism