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1、ValvularHeartDiseaseDr.RandaAl-HarizyProf.ofInternalMedicineTricuspidValveMITRALSTENOSISAlmostallmitralstenosisisduetorheumaticheartdisease.Itismuchmorecommoninwomen.Othercausesinclude:Lutembacher'ssyndrome,whichisthecombinationofacquiredmitralstenosisandanatrial
2、septaldefect,carcinoidtumoursandSLE.ValvularHeartDiseasePATHOPHYSIOLOGYWhenthenormalvalveorificeareaisreducedto1cm2,severemitralstenosisispresent.Tomaintaincardiacoutput,theleftatrialpressureincreasesandleftatrialhypertrophyanddilatationoccur.Consequently,pulmona
3、ryvenous,pulmonaryarterialandrightheartpressuresalsoincrease,followedbypulmonaryoedema.Pulmonaryhypertensionleadstorightventricularhypertrophy,dilatationandfailureresultingintricuspidregurgitation.ValvularHeartDiseaseCOMPLICATIONSOFMITRALSTENOSISAtrialfibrillatio
4、nSystemicembolizationPulmonaryhypertensionPulmonaryinfarctionChestinfectionsInfectiveendocarditis(rare)TricuspidregurgitationRightventricularfailureValvularHeartDiseaseSYMPTOMSUsuallytherearenosymptomsuntilthevalveorificeismoderatelystenosed(i.e.hasanareaof2cm2).
5、Becauseofpulmonaryvenoushypertensionandrecurrentbronchitis,progressivelyseveredyspnoeadevelops.Acoughproductiveofblood-tinged,frothysputumandoccasionallyfrankhaemoptysismayoccur.Rightheartfailureanditssymptomsofweakness,fatigueandabdominalorlowerlimboedema.Atrial
6、fibrillation,givingrisetopalpitations.Atrialfibrillationmayresultinsystemicemboli.ValvularHeartDiseaseSIGNSFace:mitralfaciesormalarflush.Pulse:asmall-volumepulse,maybeanirregularlyirregularpulse.Jugularveins:Distensionofjugularveinsinrightheartfailure.Palpation:T
7、hereisatappingimpulsefeltparasternallyontheleftside(palpablefirstheartsound).Asustainedparasternalimpulseduetorightventricularhypertrophymayalsobefelt.Auscultation:loudfirstheartsound,and'openingsnap'.Thisisfollowedbyalow-pitched'rumbling'mid-diastolicmurmuratthe
8、apexwithpresystolicaccentuation.ValvularHeartDiseaseINVESTIGATIONSChestX-ray:smallheartwithanenlargedleftatrium,Pulmonaryvenoushypertension,acalcifiedmitralval
