VALVULAR HEART DISEASE

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VALVULAR HEART DISEASE

• Shen Jieyan MD
• SSMU
• Department of cardiology

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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 exuduation, proliferation (Aschoff
  nodes), scarring

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Rheumatic Fever

• Clinical Manifestations
• fever, rheumatic carditis, arthritis,
  chorea, deformity of skin
• Laboratory finding
• ASOgt500U, ASKgt80U, ESR?,Alb?,?a2? CRP(),
• CPK-MB?, GOT?,TnT TnI?, C3?, IgA?

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Rheumatic Fever

• Diagnosis Jones standards, 1992 AHA
• Treatment
• 1) rest
• 2) antibiotics Penicillin
• 3) anti- inflammation Aspirin
• 
  Corticosteroids
• 4) others
• Prevention

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Mitral Stenosis

• 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,
  funnel-shaped

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Mitral Stenosis

• Pathophysiology
• normal cross-sectional area4-6 cm2
• mild MS lt2 cm2, LAP??LAH
• ---compensated period
• moderate MS lt1.5 cm2, PVP?, PCWP?,
• ?interstitial edema
• severe MS lt1.0 cm2,PAP??RVoverload
• ?RV failure ?TR ?PR
  

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Mitral Stenosis

• Clinical Manifestations (MVAlt1.5cm2)
• 1. Symptom dyspnea, hemoptysis, cough,
• hoarseness (ortners
  syndrome)
• 2. Signs
• -Mitral faces
• -Diastolic thrill at apex
• -S1?(flexible), OS, Diastolic rumbling
  murmur
• at apex,
• -P2?, splitting, Graham-Steel murmur(PR),TR

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Mitral Stenosis

• 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, Two-
• dimensional,
  Doppler

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????????Rheumatic mitral stenosis
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????????Rheumatic mitral stenosis
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????????Rheumatic mitral stenosis
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????????Rheumatic mitral stenosis
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????????Rheumatic mitral stenosis
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Mitral Stenosis

• 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

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Mitral Stenosis

• 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

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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, Rheumatic
• - Involvement of papillary muscle CAD

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Mitral Regurgitation

• 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

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Mitral Regurgitation

• Clinical Manifestations
• (1) Symptoms asymptomatic( gradually,gt20
  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?

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Mitral Regurgitation

• 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

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Mitral Regurgitation

• Diagnosis
• systolic murmur at apex LA?, LV? Echo
• Differential Diagnosis
• relative MR, ventricular septal defect,
• tricuspid regurgitation, aortic stenosis
• Management
• - Medical treatment
• - Surgical treatment

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Aortic Stenosis

• Etiology Pathology
• - Rheumatic AS, Congenital AS,
• Degenerative calcific AS
• Pathophysiology
• - Obstruction to LVOT? LVH? LAH? PVP??
• Pulmonary edema
• - LVEF??ischemia of peripheral?brain?heart

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Aortic Stenosis

• 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

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Aortic Stenosis

• Laboratory Examination
• ECG X- film
• Echocardiography Angiography
• Diagnosis Differential Diagnosis
• - murmur Echo
• - MI, TI, VSD
• - other murmurs of LVOT obstruction

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???????????? Rheumatic aortic stenosis and
regurgitation
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???????????? Rheumatic aortic stenosis and
regurgitation
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???????????? Rheumatic aortic stenosis and
regurgitation
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???????????? Rheumatic aortic stenosis and
regurgitation
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Aortic Stenosis

• Complications
• Sudden death, heart failure, arrhythmia,
• infective endocarditis, systemic embolism
• Management
• - Medical treatment
• - Surgical treatment

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Aortic Regurgitation

• 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

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Aortic Regurgitation

• Pathophysiology
• - LV receives both blood from LA AO
• ?volume overload ?LV dilation ?
• pulmonary edema ?relative MI,MS
• - Diastolic pressure?,pulse pressure?

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Aortic Regurgitation

• Clinical Manifestations
• - Symptom palpitation, angina
• - Sign apical impulse? left, inferior
• cardiac dullness ?left, inferior
• Boot-shaped shadowcardiac waist?
• DM in AV2 area ?apex
• S1?,A2?
• relative MISM at apex
• relative MSAustin Flint

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Aortic Regurgitation

• 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

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Aortic Regurgitation

• Diagnosis Differential Diagnosis
• AI peripheral vascular signs Echo
• Complication infective endocarditis
• ventricular arrthymia
• heart failure

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Aortic Regurgitation

• Management
• Medical treatment
• Surgical treatment