1 / 30

Mitral regurge

Mitral regurge. Prof. Lotfy Hamed Abo dahab . Professor Of Internal Medicine. Faculty Of Medicine Sohag University.

jamesejackson
Download Presentation

Mitral regurge

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mitral regurge Prof. LotfyHamedAbodahab. Professor Of Internal Medicine. Faculty Of Medicine Sohag University.

  2. Mitral regurgeProper closure of the MV depends on: -Normal leaflets,-Normal CT to keep the leaflet in place, -Normal contractile papillary muscles to pull down the valve cusps during systole and prevent their displacement into the atrium-Normal size of the MV ring.

  3. -Etiology of MR:.MR can result from diseases involving any of the different components of the MV as:.1-Mitral valve prolapse2-Rheumatic fever3-Dilatation of the MV ring as in HF.4-Dysfunction of the MV leaflets due to ischemia, infarction,.5-Connective tissue disease6-Annular calcifications7-Congenital cardiac conditions8-Acute mitral regurgitation (infective endocarditis – myxomatous degeneration – truma – acute myocardial infarction)9-Weight loss agents as: dexfenfluramine – fenfluramine & fenteramine

  4. Effects:.1-LA is dilated and its pressure rises due to regurgitation of blood from LV into LA each systole.2-During diastole the large amount of blood in the LA flows to the LV across a nonstenotic MV producing turbulence of blood flow and relative MS.3-LV is dilated due to volume overload.4-LV failure lead to pulmonary congestion, HTN5-AF may occurClinical Picture:.Symptoms:.1-Mild to moderate MR is asymptomatic.2-When LV failure occurs, symptoms of pulmonary congestion appear.3-Symptoms of pulmonary HTN.

  5. Signs:.1-LV volume overload causes:. -Hyperdynamic apex beat (displaced outward and downward).2-Regurgitation through MV causes:. -Systolic thrill at the apex. -Pan systolic murmur, propagating to the axilla. -Faint 1st HS due to (In diastole, the MV floats on the top of blood filling the LV. When systole starts the valve is already semi closed)3-Rapid flow of blood across the MV in diastole causes:. -3rd HS -Mid diastolic murmur.

  6. * Acute mitral regurge:.Mechanism:. 1-Papillary muscle dysfunction, or rupture complicating AMI.2-MV perforation in infective endocarditis.3-Ruture CT in MVP (myxomatous degeneration).The degree and symptoms of pulmonary congestion are much greater than in chronic MR. This is because LV contraction forces the regurgitant blood into non-compliant LA still of normal size. Acute pulmonary edema may develop, and shock may develop. These patients may need urgent surgical correction.

  7. *Mitral valve prolapse:.- Prolapse of the redundant MV leaflets into the LA may occur in 10% of normal population.-Causes:. 1-Unknown 2-Marfan syndrome 3-Congenital anomaly (either isolated MVP, or in association with ASD). 4-Myxomatous degeneration of the MV.-MR may develop.-Non-specific chest pain and palpitation due to recurrent arrhythmia (usually respond to Beta blockers).-By auscultation: mid systolic click and may be late systolic murmur due to MR (click murmur syndrome).

  8. Investigation to MR:.1-X-ray picture:.1-LA enlargement 2-LV enlargement3-Pulmonary congestion & HTN

  9. 2-ECG:.-Normal -LV, LA hypertrophy - RVH -AF

  10. 3-Echocardiograhy:. -Degree of LV, and LA dilation -Degree of MR -PH

  11. DifferentialDiagnosis:.1-TR 2-VSDComplications:.1-LV failure, PH and RV failure. 2-AF. 3-Thrombi in the LA may lead to systemic embolization 4-Thrombosis in the RA may also occur and result in pulmonary embolism 5-Infective endocarditis 6-Calcification of the MV 7-Recurrence of rheumatic activity

  12. Treatment:.1-Prophylaxis against RF 2-Prophylaxis against IE. 3-Treat complications as HF, arrhythmias. 4-Afterload reducing agent as: Nitrates & vasodilators 5- ACE inhibitors (decrease the LV size) 6-Regular follow up of all patients , clinically and by Echo. *Asymptomatic patients with stable LV dimensions can be treated medically. *Symptomatic patients, severe MR ,and evidence of progressive LV dilatation Surgery must be advised before impairment of LV function. * MV repair * MV replacement.

  13. Thank You

More Related