Valvular heart disease瓣膜性心脏疾病.ppt

心脏瓣膜病 The First Affiliated Hospital of Guangzhou Medical UniversityDepartment of CardiovascularChen ailan(陈 爱兰) 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 Rheumatic Heart Disease Inflammatory process that may affect the myocardium, pericardium and or endocardium Usually results in distortion and scarring of the valves Rheumatic Heart Disease, cont. Subjective symptoms Prior history of rheumatic fever General malaise Pain – may or may not be present Objective symptoms Temperature Murmurs Dyspnea polyarthritis Rheumatic Heart Disease Diagnosis H/P WBC and ESR C-reactive protein Cardiac enzymes EKG Chest x-ray Echo Cardiac cath Cardiac output Rheumatic Heart Disease Nursing Care Vital signs Rest and quiet environment Give antibiotics, digitalis, and diuretics Provide adequate nutrition Monitor ISO Explain treatment and home care Types Mitral Stenosis Mitral Regurgitation Mitral Valve Prolapse Aortic Stenosis Aortic regurgitation Tricuspid valve is affected infrequently Tricuspid stenosis – causes Rt HF Tricuspid regurgitation –causes venous overload Mitral Stenosis A 75 year old woman with loud first heart sound and mid-diastolic murmur Chronic dyspnea Class II/VI Fatigue Recent orthopnea(端坐呼吸) Nocturnal palpitationPND（夜间阵发性呼吸困难） Pedal edema Mitral Stenosis: Etiology Primarily a result of rheumatic fever Scarring fusion of valve apparatus Degenerative (calcification) Rarely congenital Pure or predominant MS occurs in approximately 40% of all patients with rheumatic heart disease Two-thirds of all patients with MS are female. Mitral Stenosis:Pathophysiology Normal valve area: 4-6 cm2 Mild mitral stenosis: MVA 1.5-2.5 cm2 Minimal symptoms Mod mitral stenosis MVA 1.0-1.5 cm2 usually does not produce symptoms at rest Severe mitral stenosis MVA 1.0 cm2 Mitral Stenosis:Pathophysiology M