心瓣膜病本科课件.ppt

1、正常心脏解剖动画正常心脏解剖动画因炎症因炎症(最常见风湿热最常见风湿热)、粘液样变性、退行性变、粘液样变性、退行性变、先天性畸形、缺血坏死、创伤等原因所引起的单先天性畸形、缺血坏死、创伤等原因所引起的单个或多个瓣膜结构异常个或多个瓣膜结构异常(瓣叶、瓣环、乳头肌或瓣叶、瓣环、乳头肌或腱索腱索)，导致瓣膜狭窄和（或）关闭不全。，导致瓣膜狭窄和（或）关闭不全。由于青霉素广泛使用，使风湿发病率明显下降。近年来随着心超检查的普及，二尖瓣脱垂日益多见。而全球人口老化，钙化性主动脉瓣狭窄的发生率正在增高。Rheumatic FeverRheumatic MSThe Second Affiliated Ho

2、spital of Wenzhou Medical CollegeCardiology department【二狭的病解前面观】【二狭的病解前面观】The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department Rheumatic MS The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department【二【二 尖尖 瓣瓣 狭狭 窄窄 伴伴 左左 房房 扩大扩大】The Second Affiliated Hos

3、pital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department肺小动脉反射性收缩肺小动脉反射性收缩肺小动脉硬化肺小动脉硬化 The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCar

4、diology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medica

5、l CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department肺动脉瓣听诊区肺动脉瓣听诊区舒张早期叹气样杂音舒张早期叹气样杂音The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe

6、Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology de

7、partmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeC

8、ardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentDr.Nitin M.Kulkarninm2kmailexciteThe Second Af

9、filiated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentT

10、he Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentheartcenteronlineThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department球囊到位充盈时球囊中部被狭窄的二尖瓣压迫成“腰征”球囊完全膨胀“腰征”消失The Second Af

11、filiated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department急

12、性：急性：左房、左室容量负荷骤增，左室急性扩左房、左室容量负荷骤增，左室急性扩张能力有限，左室舒张末压、左房压急剧上升张能力有限，左室舒张末压、左房压急剧上升导致，肺淤血、肺水肿。导致，肺淤血、肺水肿。慢性：慢性：左室舒张末容积增大，左室舒张末容积增大，Frank-starling机机制来维持心搏量，如制来维持心搏量，如MR持续存在，则失代偿。持续存在，则失代偿。The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department早期无明显症状，可保持较长时间，甚至超过20年.一旦出现明显症状，多已有不可逆

13、心功损害。心悸 咳嗽 劳力性呼吸困难 乏力，但急性肺水肿、咯血及栓塞少 The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department心尖搏动The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department收缩期杂音The Second Affiliated

14、 Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentNormal chest x-rayCardiac enlargementThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentElectrocardiographic Evidence of L.Ventricular Hyp

15、ertrophy (Large S in V1,Large R in V4)and Minor Atrial Abnormality(Broad P)The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology d

16、epartment二尖瓣前叶二尖瓣脱垂 呈吊床样改变二尖瓣后叶The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department外科治疗外科治疗The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospi

17、tal of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department正 常异 常The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Secon

18、d Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departm

19、entThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department正 常异 常The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical College

20、Cardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department三、心尖抬举样搏动，向左下移位三、心尖抬举样搏动，向左下移位The Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology departmentThe Second Affiliated Hospital of Wenzhou Medical CollegeCardiology department 谢 谢