Post on 25-Feb-2018
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MITRAL
REGURGITATION
Present by
Dionisius Giri S
(C111 09 309)
Supervisor :
dr. Muzakkir !ir" Sp.#P.$%&"$%C
CS' P'S'**%+
Depart!ent o, Cardio-oy and /asu-ar MediineMedia- $au-ty o, &asanuddin niversity
Makassar 201
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PATIENT IDENTITY
Name : Mrs. DS
Age : 25 years old
Gender : emale
MR : !"!#$5 Day o% Adm&ss&on : 'an(ary ##)*
2+#"
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,ISTORY TA-ING*&e% om/la&n) : S*or)ness o% 0rea)*
,&s)ory o% &llness:
S(1ered s&ne 3 #years ago and go) 4orsen 5
days 0e%ore adm&))ed )o )*e *os/&)al. I) 4as
e/er&ened 4*&le do&ng m&n&mal a)&6&)y
4al7&ng )o )*e 0a)*room and rel&e6ed 4&)*
res)&ng. Some)&mes a4a7ed d(r&ng a) n&g*) )&me
)*a) a(sed 0y s(dden s*or)ness o% 0rea)*8
/a)&en) slee/ 4&)* s&) /o)&)&on. *es) /a&n 9;8 on
)*e le%) *es)8 s&ne # mon)* ago 0e%ore
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s/read (n)&l )o )*e le%) arm8/ene)ra)e)o )*e 0a78 %eels l&7e 7neaded. o(g*9; s&ne ! days ago 4&)* s/()(m o%4*&)e olo(red8 e6er 9
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,&s)ory o% DM 9
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RIS- ATORS
on4 Modi5edModi5ed
Gender : emale
Age
,&/er)ens&on
D&a0e)es
Mell&)(s
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Genera- Status
Modera)e &llness@ ?ell no(r&s*ed@ ons&o(s
N()r&)&onal S)a)(s: Normal ?e&g*) : 5+ 7g
,e&g*) : #55 m
MI : 2+.$ 7g@m2
/ita- Sin
lood Press(re : #++@B+ mm,g
P(lse Ra)e : ##" 0/m Res/&ra)ory Ra)e : =2 )/m
Tem/era)(re : =!.$ + 9a&lla;
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P,YSIAL ECAMINATION
,ead and Ne7 Eam&na)&onsEye : on(n)&6a anem& 9
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Ins/e2)&on:,ear)a/e54asno)6&s&0lePal/a)&on:,ear)a/e54asno)/al/a0lePer2(ss&on:R&g*)*ear)0order&nr&g*)
/aras)ernall&ne8Le%)*ear)0order&nle%)m&d2la6&2(larl&neIS>.
A(s2(l)a)&on:,ear)So(nds:SI@IIreg(lar8m(rm(r9;s&s)ol&7grade=@!a/e5
&eart
Ins/e2)&on:la)8%ollo4s0rea)*&ngmo6emen)A(s2(l)a)&on:Per&s)al)&2so(nd9;8normalPal/a)&on:Nomass8no)enderness8l&6erand
s/leen(n/al/a0le
Per2(ss&on:Tym/an&9;
bdo!en
Pre)&0&aledema@Dorsal/ed&sedema@
'6tre!itie
s
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Ele)roard&ogram 9EG; #"@#@2+#"
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EG &n)er/re)a)&on
R*y)*m: S&n(s r*y)*m
,ear) ra)e : ##B 0/mReg(lar&)y : reg(lerA&s : RADP 4a6e : P m&)ral +8#2 s on II8a6L leadPR &n)er6al : +82+ sH /a)*olog&es : %(n)&on &s good8 E !=8==9on )a*&ard&;
D&mens&onal *am0ers o% *ear):LA8RA8R> d&la)a)&on
Derease R> %(n)&on
MR se6ere
TR modera)e
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?or7&ng DIAGNOSIS
Se6ere MITRALREGURGITATION
, NY,A III
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MANAGEMENT 2 7r
Dobuta!in ?>kA @a!> SP i,
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I!CU!!I
"ITRL RGURGITTI
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or!a- !itra- va-ve ,untiondepends on per,et ,untiono, t7e o!p-e6 interation
beteen t7e !itra- -eaets"t7e subvu-var apparatus(7ordae tendinae andpapi--ary !us-es)" t7e!itra- annu-us" and t7e -e,tventri-e.An &m/er%e)&on &n any one o% )*ese
om/onen)s an a(se )*e 6al6e )o lea7.
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Mitra- reuritation &s
re)rograde o4 o% 0lood %romL> )o LA )*ro(g* &nom/e)en)m&)ral 6al6e d(r&ng sys)ol&/*ase.
Causes by Pr&mary 9&n)r&ns&6al6(lar d&sease; and
(n)&onal 9reg&onal or glo0al
L> remodell&ng ;
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Pri!ary (intrinsiva-vu-ar
disease)
MR &s almos) al4ays9K+; asso&a)ed 4&)*MS &n R,D
Degenera)&6e/roesses o% leae)sand *ordals)r()(res
In%e)&6e endoard&)&s
M&)ral ann(laral&a)&on
S)r()(rally normalleae)s and *ordae)end&neae
Is*em& *ear) d&sease9Is*em& MR;
Id&o/a)*& d&la)edard&omyo/a)*y
M&)ral ann(lard&la)a)&on
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E)&ology
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Pa)*o/*ys&ology o% MR
Mitral regurgitation
Systolic (Retrograde) ejection into LA
Acute Chronic
Volume overload in LA & LV ed LV afterload (into LA)
ed LA! LV "ressure ed LA#LV si$e# com%liance
"ulmonary edema ed Cardiac out%ut LA dilatation ed contractilityA C'"ulmonary congestion
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Pa)*o/*ys&ology
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Sym/)oms o% MR
Dys/nea
a)&g(e
Or)*o/nea
Pal/&)a)&on
P(lmonary edema 9o%)en )*e&n&)&al man&%es)a)&on;
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P*ys&al EamPal/a)&on may re6eal )*e %ollo4&ng:
r&s7 aro)&d (/s)ro7e and *y/erdynam& ard&a&m/(lse
Prom&nen) L> ll&ng 4a6e
A(s(l)a)&on may re6eal )*e %ollo4&ng: D&m&n&s*ed S#&n a()e MR and *ron& se6ere MR
4&)* de%e)&6e 6al6e leae)s
?&de s/l&))&ng o% S2as a res(l) o% early los(re o%
)*e aor)& 6al6e
S=as a res(l) o% L> dys%(n)&on or &nreased 0lood
o4 aross )*e M>
Aen)(a)ed P2&% /(lmonary *y/er)ens&on &s
/resen)
*ara)er&s)& m(rm(r
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A(s(l)a)&on
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l&n&al ea)(res
ute
Presen) 4&)* s(ddenonse) o% /(lmonaryedema8 *y/o)ens&o8
ard&ogen& s*o7M(rm(r early
sys)ol&8 so%)&na(d&0le
Normal LA s&e andom/l&ane
C7roni
Us(allyasym/)oma)&8 &%)*ere &s /resen) 4&)*
lo4 O sym/)omO6er )&me ,
%ea)(res
Inreased LA s&e
Lo4er O
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D&agnos)& Tes)s CR: LA and L> enlargemen)
EG: L> *y/er)ro/*y8
some)&mes A
E*o:
LAE L> enlargemen)
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Med&al T*era/y
AE
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S(rg&al &n)er6en)&on
Sym/)oma)& 4&)* se6ere MR
Asym/)oma)& 4&)* se6ere MR and/reser6ed L> %(n)&on
Asym/)oma)& 4&)* se6ere MR andL>ESD "5 mm and E J 55
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I!CU!!I
HEART FAILURE
DEINITION
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T*e s)a)e &n 4*&*a0normal &r(la)ory
onges)&on o(rs as )*eres(l) o% *ear) %a&l(re.
DEINITION
,ear) &s no longer a0le )o /(m/ anade(a)e s(//ly o% 0lood &n rela)&on)o )*e 6eno(s re)(rn and &n rela)&on)o )*e me)a0ol& needs o% )*e 0ody)&ss(es a) )*e /ar)&(lar momen)
.onges
)&6e
,ear)
a&l(re
,ear)
a&l(r
e
ETIOLOGY O ,EARTAILURE
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ETIOLOGY O ,EARTAILURE
M&oardD&sease
AD
ard&omyo/a)*y
Ia)rogen&
M&oard&)&s
Mioard Me7ania-Dys,untion
Press(re o6erloaded
9S)enos&s Aor)ae8,y/er)ens&on8 oar)a)&oAor)ae;
>ol(me O6erloaded
9M&)ral@Aor)ae Reg(rg&)a)&on8ongen&)al ,ear) D&sease8
,&/er)rans%(s&on;
M&oard &ll&ng In*&0&)a)&ng
(Cardia *a!ponade"Periarditis)
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*7e $ra!in7a! riteria ,or C&$C&$ onsidered present i, 2 !a@or or 1 !a@or E 2 !inor
Maor r&)er&a M&nor r&)er&a
Paroysmal No)(rnal
Dys/nea
ard&omegaly
Gallo/ S=
,e/a)o(g(lar re(
Inreased o% '>P
Rales or ron*&
A()e /(lmonary edema
Prolonged &r(la)&on
)&me9 25 se;
?e&g* loss "85 7g &n 5
days &n
E)rem&)y edema
No)(rnal o(g*
Dereased 6&)al
/(lmonary a/a&)y
9#@= o% ma&mal;
,e/a)omegaly
Ple(ral e1(s&on
Ta*yard&a 9
#2+0/m;
Dys/nea dQe1or)
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lASSIIATION O ,
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PAT,OP,YSIOLOGY O ,
Pla(e &noronaryar)ery
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S&gn sym/)om/ o% *%
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Lo4 sal)8 eno(g*
alor&es and/ro)e&ns de)ary
Red(e P*ys&alA)&6&)y
O/)&mal&edO&gena)&on
, MANAGEMENT
Nonenod&la)or
AE&n*&0&)orsAR
0lo7ers
0lo7ersAE&n*&0&)orsAR
C&$ MG'M'*
arma7olog&
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T*an7 Yo(