心左心房右心室左心室二尖瓣mitremitral valve前 叶后 叶二尖瓣狭窄Mitral StenosisX号选手CONCENTS目录定义及病因学01病理生理改变02临床表现03诊断047 定义01 二尖瓣狭窄即在二尖瓣瓣膜水平发生左室流入道的梗阻，它是二尖瓣结构异常、限制左室舒张期二尖瓣正常开放的结果。8 病因学01链球菌9 病理改变01鱼嘴样改变左心房左心室左房压心排量11 连环堵0212 病理生理机制02左房压肺静脉压肺毛细血管肺动脉压右心压力13 呼吸困难 dyspnea03早期劳力性呼吸困难晚期夜间阵发性呼吸困难 / 端坐呼吸咯血 hemoptysis 03粉红色泡沫痰大量咯鲜血肺梗死性咯血淤血性咯血支气管静脉破裂晚期并发症咳嗽 / 声音嘶哑03压迫支气管压迫喉返神经左心房心悸03左心房心房颤动17 二尖瓣面容03—— 《黄帝内经》右心衰体循环淤血还原血红蛋白增多mitral face18 杂音03Normal二尖瓣听诊区舒张期隆隆样杂音MSMS (AF)19 X 线检查03左房增大肺动脉突出右室增大食道下段受压20 超声心动图0321 诊断04• 病史与症状• 典型心脏杂音• 超声心动图22 分度04Normal4.0-6.0cm2Mild MS1.5-2.0cm2Moderate MS1.0-1.5cm2Severe MS＜1.0cm2- - 预习任务- -24 课堂小结342分度临床表现体征25 高原红西藏地区“高原红”产生的原因与二尖瓣狭窄面容有什么相似之处和不同点？课后思考杂音除了舒张期隆隆样杂音，二尖瓣狭窄患者还可能出现哪些特殊心音及杂音，产生的机制是什么？26 参考资料 / 拓展阅读[1] Iung B, Baron G, Butchart E G, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease[J]. Eur Heart J, 2003, 24(13):1231-1243.[2] Vahanian A, Alfieri O, Andreotti F, et al. [Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)] [J]. G Ital Cardiol (Rome), 2013,14(3):167-214.[3] Nishimura R A, Otto C M, Bonow R O, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. J Thorac Cardiovasc Surg, 2014, 148(1):e1-e132.27 保持微笑X
