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1、VALVULARHEARTDISEASEShenJieyanMDSSMUDepartmentofcardiologyRheumaticFeverDefinition:autoimmunediseasecausedbystreptococcalinfection,cross-reactbetweenstreptococcalantigensandstructuralglycoproteinofheart,joints,centralnervessystemandconnectivetissue.Pathology:exuduation,proliferati
2、on(Aschoffnodes),scarringRheumaticFeverClinicalManifestations:fever,rheumaticcarditis,arthritis,chorea,deformityofskinLaboratoryfinding:ASO>500U,ASK>80U,ESR↑,Alb↓,γ+a2↑CRP(+),CPK-MB↑,GOT↑,TnTTnI↑,C3↑,IgA↑RheumaticFeverDiagnosis:Jonesstandards,1992AHATreatment:1)rest2)antibiotics:P
3、enicillin3)anti-inflammation:AspirinCorticosteroids4)othersPreventionMitralStenosisEtiology:predominantcause:rheumaticfeverrarecausePathology:thickening,shortening,adhering,calciumdepositing,andscarringfourformsoffusion:(1)commissural,(2)cuspal,(3)chordal,(4)combinedtwotypesofshap
4、e:fish-mouthshaped,funnel-shapedMitralStenosisPathophysiology:normalcross-sectionalarea:4-6cm2mildMS:<2cm2,LAP↑→LAH---compensatedperiodmoderateMS:<1.5cm2,PVP↑,PCWP↑,→interstitialedemasevereMS:<1.0cm2,PAP↑→RVoverload→RVfailure→TR→PRMitralStenosisClinicalManifestations(MVA<1.5cm2)1.
5、Symptom:dyspnea,hemoptysis,cough,hoarseness(ortner’ssyndrome)2.Signs:-Mitralfaces-Diastolicthrillatapex-S1↑(flexible),OS,Diastolicrumblingmurmuratapex,-P2↑,splitting,Graham-Steelmurmur(PR),TRMitralStenosisLaboratoryExamination-ECG:1)leftatrialenlargement:Pwave(II,V1)2)Af;3)rightve
6、ntricularhypertrophy-X-film:changeincardiacsilhouette,KerleyBlines-Echocardiography:M-mode,Two-dimensional,Doppler正常二尖瓣形态风湿性二尖瓣狭窄Rheumaticmitralstenosis风湿性二尖瓣狭窄Rheumaticmitralstenosis风湿性二尖瓣狭窄Rheumaticmitralstenosis风湿性二尖瓣狭窄Rheumaticmitralstenosis风湿性二尖瓣狭窄RheumaticmitralstenosisMitra
7、lStenosisDiagnosis&Differentialdiagnosis-Diastolicrumblingmurmuratapex+X-film+ECG+Echo-relativeMS;Austin-Flintmurmur;leftatrialmyxoma;GrahamsteellmurmurComplication:Atrialfibrillation;acutepulmonaryedema;congestiveheartfailure;thromboembolism;infectiveendocarditis;pulmonaryinfecti
8、veMitralStenosisManagement:-Medic
