Mitral Stenosis & Insufficiency 11-7-13
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Transcript of Mitral Stenosis & Insufficiency 11-7-13
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Valvular Heart Diseasedr Putra Hendra SpPDUNIBA
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Cardiac Anatomy 101
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Spectrum of VHD Aortic Valve Mitral Valve Tricuspid Valve Pulmonic Valve
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Spectrum of VHD Regurg Aortic Valve Stenosis Regurg Mitral Valve Stenosis Regurg Tricuspid Valve Stenosis Regurg Pulmonic Valve Stenosis
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Spectrum of VHD RegurgAcuteAortic ValveChronicStenosisAcuteChronicRegurgAcuteMitral ValveChronicStenosisAcuteChronicRegurgAcuteTricuspid ValveChronicStenosisAcuteChronicRegurgAcutePulmonic ValveChronicStenosisAcuteChronic
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Mitral Valve Disease: EtiologyMitral StenosisRheumatic - 99.9%!!!CongenitalProsthetic valve stenosisMitral Annular CalcificationLeft Atrial Myxoma
Acute Mitral RegurgitationInfective endocarditisIschemic Heart diseasePapillary ms ruptureMitral valve prolapseChordal ruptureChest trauma
Chronic Mitral RegurgitationIschemic Heart diseasePapillary ms dysfunctionInferior & posterior MIMitral Valve prolapseInfective endocarditisRheumaticProstheticMitral annular calcificationCardiomyopathyLV dilatationIHSS
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Valvular Heart DiseaseMitral Valve
Mitral RegurgitationMitral Stenosis
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Mitral RegurgitationEtiologies
Alterations of the Leaflets, Commissures, AnnulusRheumaticMVPEndocarditis
Alterations of LV or LA size and FunctionPapillary Muscle (Ischemic, MI, Myocarditis, DCM)HOCMLV Enlargement Cardiomyopathies - LA Enlargement from MR MR begets MR
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Mitral Regurg pathophysiology
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Mitral Regurg pathophysiology
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Mitral Regurg pathophysiology
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Mitral RegurgitationSymptoms
Fatigue and weakness Dyspnea and orthopneaRight sided HFMVP Syndrome (if present)
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Mitral RegurgitationPhysical Exam
Holosystolic Apical Blowing Murmur Laterally displaced apical impulseSplit S2 (but is obscured by the murmur)S3 Gallop (increased volume during diastole)Radiation depends on the etiology
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Mitral Regurgitation- SBE Prophylaxis
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Mitral Regurgitation
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Mitral Regurgitation -MVP
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Mitral Regurgitation -MVP
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Mitral StenosisEtiologiesRheumatic almost all cases in adultsMitral Annular Ca+ - massive (rare)Congenital rare
60% of pts dont have a history of ARC50% of pts who have ARC dont develop VHD
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Mitral Stenosis
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Mitral Stenosis
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Mitral Stenosis
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Mitral StenosisPhysical ExamLoud S1Opening SnapDiastolic Apical Rumble (murmur)May be associated with:MR or ASRight Sided MurmursPI Graham Steel MurmurTR
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Mitral StenosisTreatment of Symptomatic Mitral Stenosis
Medical Therapy treats the symptoms not the causeDiuretics for congestionDigoxin, Beta and Ca Channel Blockers for Afib rate controlAnticoagulation for AFib and LA clotsSBE Prophylaxix prevent endocarditis
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Mitral StenosisTreatment of Symptomatic Mitral Stenosis
Surgical Therapy treats the causePercutaneous Ballon Valvulaoplasty Non-calcified, pliable valve
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Balloon Mitral Commissurotomy
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Mitral StenosisTreatment of Symptomatic Mitral Stenosis
Surgical Therapy treats the causeOpen Commisurotomy valve repairMitral Valve Replacement
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