1. Overview:
1.The main element of mitral stenosis (MS) is rheumatic fever, which is more common after acute rheumatic fever, and some patients have no history of acute rheumatic fever, but most of them have a history of upper respiratory tract infections caused by recurrent streptococcal infections.
2.Age of formation: It takes at least 2 years for mitral stenosis to develop after acute rheumatic fever. Most patients are asymptomatic for more than 10 years.
3.Age of onset: generally 40 to 50 years old, female patients are the majority, accounting for about 2 3.
2. Anatomy: Under normal circumstances, the mitral valve area is 4-6C, and mild stenosis: 15c㎡;Moderate stenosis: 10-1.5c㎡;Severe stenosis: 10c㎡。
3. Normal physiology: The normal heart can contract and relax, so when the heart is in relaxation, the mitral valve is opened, and the blood flows from the left atrium to the left ventricle, waiting for contraction and pumping.
4. Pathophysiology: If the mitral valve is stenosis, then the left ventricle will not be filled, and there is a transvalvular pressure difference between the left atrium and the left ventricle, which can judge the degree of mitral valve stenosis!(as shown below).
When the left atrium has no strength to pump blood - left atrial congestion - pulmonary veins (arterial blood) - pulmonary edema - pulmonary artery congestion (venous blood) - high pressure on the right heart and a lot of work - right heart failure.
5. Clinical manifestations:
1.Most common: dyspnea on exertion.
2.Paroxysmal cough.
3.Hemoptysis: massive hemoptysis: rupture of bronchial veins, blood in sputum: pulmonary edema, infection, jelly sputum: late pulmonary infarction.
4.Mitral valve stenosis – which induces atrial fibrillation – is prone to thromboembolism (most common in the brain).
5.Pulmonary artery congestion dilates and compresses the recurrent laryngeal nerve: hoarseness;Left atrial enlargement: compression of the esophagus, difficulty swallowing. 6.Chest pain: right ventricle enlargement, decreased cardiac pumping, myocardial ischemia.
6. Signs:
1.Inspection: "Mitral Valve Countenance" - red cheekbones, purple lips. 2.Palpation: palpable diastolic tremor at the apex 3Percussion: dilatation of the cardiac dullness boundary. 4.Auscultation: mid- and late diastolic rumbling murmur in the apical area. 5.Signs of right heart failure: palpable hepatomegaly, tenderness, dry jugular venous reflux (+) leg edema, ascites.
7. Auxiliary examination:
1.Echocardio** (confirmed);2.ECG: mitral valve p-wave, right ventricular hypertrophy;3.X-ray: pear-shaped heart.
8. **1Compensatory period**: 1) Maintain or improve the compensatory function of the heart;(2) Prevention of streptococcal infections and rheumatic fever activity.
2.Decompensated**: rest, sodium restriction, oral or intravenous diuretics, digitalis for atrial fibrillation and heart failure**.
3.Instruments**: 1) Percutaneous balloon mitral valvuloplasty – when mitral valve orifice 15c, symptoms are progressively worsening, and pulmonary hypertension is preferred. (2) Prosthetic valve replacement: when the valve is calcified. Autumn and Winter Check-in Challenge