PATHOPHYSIOLOGY mitral valve orifice is 4 to 6 cm mild: 1.5-2cm2 moderate: 1-1.5cm2 Severe(critical): <lcm2 transvalvular pressure gradient, pulmonary venous and arterial wedge pressures elevated exertional dyspnea 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @
PATHOPHYSIOLOGY • mitral valve orifice is 4 to 6 cm2 mild：1.5-2cm2 moderate：1-1.5cm2 Severe (critical)：1cm2 • transvalvular pressure gradient, pulmonary venous and arterial wedge pressures elevated - exertional dyspnea
o Tachycardia augments the transvalvular gradient and La pressure the Co is abnormal at rest and may fail to rise or may even decline during activity in patients with severe Ms o Pulmonary hypertension 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @
• Tachycardia augments the transvalvular gradient and LA pressure •the CO is abnormal at rest and may fail to rise or may even decline during activity in patients with severe MS • Pulmonary hypertension
CLINICAL MANIFESTATIONS As MS progresses > No symptoms >Dyspnea, cough Orthopnea Paroxysmal nocturnal dyspnea Hemoptysis rupture of pulmonary-bronchial venous connections 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @
CLINICAL MANIFESTATIONS • As MS progresses No symptoms Dyspnea, cough Orthopnea Paroxysmal nocturnal dyspnea • Hemoptysis rupture of pulmonary-bronchial venous connections
Systemic Embolism more frequent in patients with AF Other Symptoms > Hoarness (Ortner syndrome) hepatomegaly, edema, ascites, hydrothorax (right-sided heart failure) 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @
• Systemic Embolism more frequent in patients with AF • Other Symptoms Hoarness (Ortner syndrome) hepatomegaly, edema, ascites, hydrothorax (right-sided heart failure)
Phvsical Findings e Inspection and Palpation mitral facies prominent jugular venous pulse > RV tap-left sternal border diastolic thrill-apx > Hepatomegaly, ankle edema, ascites, and pleural effusion in patients with Ms and RV failure 复旦大学附属中山医院 Zhongshan Hospital, Fudan University @
Physical Findings • Inspection and Palpation mitral facies prominent jugular venous pulse RV tap-left sternal border diastolic thrill-apx Hepatomegaly, ankle edema, ascites, and pleural effusion in patients with MS and RV failure