The heart

The heart has four chambers - two atria and two ventricles

Heartbeat both of the atria contract first to pump blood into the ventricles

Then both ventricles contract to pump blood out of the heart into the arteries

There are one-way valves between the atria and ventricles, and also between the ventricles and the large arteries that take blood from the heart

5 cm2

Mitral valve stenosis

Narrowing of the heart's mitral valve. This abnormal valve doesn't open properly.

The valve leaflet may become fused or thickened that the valve can not open freely

Obstruct the flow of the blood

More stress in the left atrium Heavy work Hypertrophy and dilation of the myocardium Heart failure

Symptoms

There are no symotom untill th orifce has an area of 2 cm2. • Shortness of breath, especially with exertion or when laying down• Fatigue, especially during increased physical activity• Swollen feet or legs• Heart palpitations :sensations of a rapid, fluttering heartbeat• Dizziness or fainting• Heavy coughing, sometimes with blood-tinged sputum• Chest discomfort or chest pain• Severe headache• Trouble speaking or other symptoms of stroke

Diagnosis Investegations

Chest X-ray

Heart chamber enlargementCondition of the lungs.It shows small heart with enlarged left atrium

• Electrocardiogram (ECG)

• Echocardiogram

1. Transthoracic echocardiogram. To confirm the diagnosisof mitral stenosis.It shows the size and function of the chambers.2. Transesophageal echocardiogram. The device is inserted down in to the esophagus allows a close look at the mitral valve does

• Cardiac catheterization

Invasive technique

Threading a thin tube (catheter) through a blood vessel in the arm or groin to an artery in the heart

Injecting dye through the catheter to make the artery visible on an X-ray.

Treatments

• Medications

Diuretics to reduce fluid accumulation in the lungs or elsewhere.Blood thinners (anticoagulants) to help prevent blood clots. A daily aspirin may be included.Beta blockers or calcium channel blockers to slow the heart rate Anti-arrhythmics(Digoxin) to treat atrial fibrillation Antibiotics to prevent a recurrence of rheumatic fever

Procedures

• Repair with balloon valvuloplasty

Mitral valve surgery• Commissurotomyopen-heart surgery to remove calcium deposits and other scar tissue to clear the valve passageway• Mitral valve replacementMechanical valves, Made from metal, are durable but carry the risk of blood clots forming. need to take an anticoagulant Tissue valves: which may come from a pig, cow or human

The valve does not close properly

Blood to leak back (regurgitate) into the left atrium when the left ventricle contracts

Mitral regurgitation

Causes of mitral regurgitation

The valve is weakened(supporting tissue)

Damaged (scar).

• Degenerative changes

The most common cause.

The tissues which connect the mitral valves to the heart wall can become weak and stretched over time, which results in the valves not shutting together properly.

• Rheumatic heart disease

• Symptom

• Dyspnea (Shortness of breath with exertion), which may later develop into shortness of breath at rest and at night.• Fatigue and weakness.• Odema /Fluid buildup in the legs and feet.• Heart palpitations, if atrial fibrillation develops

Treatment

• Monitoring the heart function and symptoms

•Treating symptoms as they develop

Causes Congenital aortic stenosis 

Bicuspid aortic valve, has two flaps instead of the usual 3

Blood flow across the bicuspid valves is more turbulent,causing increased wear and tear on the valve leaflets.

Calcification, scarring, and reduced mobility of the valve leaflets

Acquired aortic stenosis 

Rheumatic fever

Aging , Calcific aortic stenosis

Atherosclerosis in the arteries of the heart

The major symptoms of aortic stenosis

Chest pain (angina) :Lack of oxygen in the heart

Fainting (syncope)

Shortness of breath (due to heart failure

Diagnosis

Electrocardiogram  Chest X-ray

Echocardiography

Cardiac catheterization

•Patients with moderate aortic stenosis (valve area 1.5 to1.0 square centimeters) are advised to avoid strenuous activities such as weight lifting or runing

• Aortic stenosis can progress over a few years. Therefore, patients are usually examined annually

• Since valve infection (endocarditis) is a serious complication of aortic stenosis, these patients are usually given antibiotics Prophylaxi

• Diuretics to reduce high lung pressures and remove lung fluid

The aortic valve area can be opened or enlarged with a balloon catheter (balloon valvuloplasty)

If severe aortic stenosis is confirmed, aortic valve replacement

Recently, aortic valves from human cadavers

Aortic regurgitation

Dyspnea oexertion, Orthopnea  Paroxysmal nocturnal dyspnea.Palpitations Angina pectorisCyanosis Circulatory shock

Diagnostic evaluation

Echocardiography

Chest X-ray

ECG

Catheterization

Treatment

1. Medical treatment

• Vasodilators

• Low sodium diet, diuretics, digoxin, calcium blockers  and avoiding very strenuous activity

•Antibiotics for endocarditis prophylaxis before dental procedures

Intervention

Valvuloplasty

Valve replacement