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Valvulopatii Flashcards

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1
Q

Regurgitare tricuspida

A

Secundar dilatarii inelului din HTP, boli ale cavitatilor stangi

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2
Q

Regurgitre pulm

A

Dilatare inel

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3
Q

Stenoza pulmonara

A

Congenital

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4
Q

Stenoza tricuspida

A

Reumatism

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5
Q

Fiziopatologie valvulopatii la modu general

A 
Solicitare fe presiune sau de volum
Compensare
Dupa vs e cam depasit
Disf miocardica
Insuf cardiaca
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6
Q

Valvulopatii evaluare genrral

A

Clinic

Ecografic!!! Tt, te, 3d(vad morfologia, mecanism, severitate, impact asupra cavitati si bernouli=>pres in artera pulm)

Test de efort(nu la stenoza aortica)
Stres ecografic cu dobutamina
Ct si angioct pt a face SCOR DE CALCIU, evaluare coronare, evaluare aorta pt TAVI
Coronarografie si cateterism

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7
Q

Regurgitare mitrala etiologie

A
  1. Foite valvulare(raa-deformare, fibroza,retractii, prolaps, endocardita)
  2. Inel (dilatare, calcificare cu imobilizare baza)
  3. Cordaje(ruptura, prolaps-elongare si ruptura, endocardita, solicitare mecanica)
  4. Muschi papilari(posteromediali) ischemie, cicatrici, deplasari prin dilatare vs
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8
Q

Regurgitare mitrala primara secundara cine e srcundara

A

Orice dilatare a vs

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9
Q

Regurgitare mitrala fiziopat

A

Sange se intoarce in as=> crestere pres si vol in as=> crestere pres in pap=>
IN ACUT ptc as nu are timp sa se dilate=> epa si dispnee
IN CRONIC=> congestie

Debit cardiac scazut( mrg initial ptc v diastolic e crescut e mentinut debitul)-asta e trecuta la cronic

E O SOLICITARE DE VOLUM A VS CA INTRA AMBELE VOLUME, logic=»»>IN TIMP DILATARE VS

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10
Q

Severitatea rm(raport dintre volum anterograd si retrograd)

A 
Dimensiune orificiu regurgitare
Gradient presiune(e accentuata de hta)
Complianta as
DURATA REGURGITARII FATA DE SISTOLA(gen la prolaps de obicei e telesistolica regurgitarea)
REZISTENTA VASCULARA SISTEMICA

Fe supranormala(postsarcina«

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11
Q

Aspect clinic regurgitare mitrala

A

Acut: epa
Cronic: astenie, fatigabilitate
Dispnee-apare fie ptc creste presiunea in as deci e umplere la presiuni mari FIE PTC AVEM DISF VS(se si hipertrofiaza putin ca tre sa intre legea laplace si trb sa scada tens)

Insuf cardiaca dreapta(ptc cresterea de presiune din venele pulmonare se transmite pana la artere si o sa apara ic dreapta): jugulare, hepatomeg, edeme, ascita;;;; apare la o rm veche si severa

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12
Q

Aspect clinic rm

A

Suflu sistolic apical IRADIAT AXILA
In rm acuta e protosistolic descrescendo(f simptomatic dar suflu mic)
In rm isvhemica-valva mitrala se ainchide oarecum excentric(ca foita post nu se inchide si se creeaza o problema de apozitie) deci fluxul e excentric spre aorta si nu spre peretele lateral al atriului stang=> iradiat superior parasternal stang sau in focarul aortic( DG DIF STENIZA AORTICA)
Z3
Cardiomegalie

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13
Q

Dg dif rm ischemica

A

Stenoza aortica
Pt dif la efort izometric creste suflul la rm(auscultatie dinamica) de ex sa si stranga pumnul
Creste rez vasc perif=> creste pres vs=> accentueaza reg mitrala

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14
Q

Rm si revarsatul oe o sg parte

A

Cica la ala sever merge mai mult spre vena pulm superioara drepata
Deci e afectat pl dr apical

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15
Q

Evaluare paraclinica

A

Ekg: hipertrofie as, vs

Rx: normal, confrstie, cardiomegalie

Eco: in special doppler pt jetul de regurgitare si vena contracta=grosime jet la originea lui

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16
Q

Criterii de gravitate vm

A 
Bruschete aparitie
Suflu descrescendo
Z3
Vs>40
Fe<60
Grad rm
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17
Q

Prolaps valva mitrala

A

Deplasare spre AS
Click sistolic
Suflu telesistolic
Risc endocardita

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18
Q

Rm ischemica

A

Valva ramane tractionata spre vs=>tenting

50:18=>

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19
Q

Stenoza aortica

Etiologie

A

Cea mai frecevnta valvulopatie!!!
Raa
Bicuspidie
Degenerativa

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20
Q

Scleroza aortica

A

Ingrosarea valvei fara efect hemodinamic

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21
Q

Fr stenoza airtica

A 
Fumat
Barbat
Varsta
Hta
Hipercolesterol??
Diabet

Seamana cu cei ai ats ptc de multe ori chiar ats da stenoza airtica

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22
Q

Scleroza aortica anato pat

A

Fibroza si calcificare foite valvulare
Fuziune comisuri(in raa)
Structura contine lipide cel infl fibroblasti calciu

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23
Q

Ce fimensiune are o valva stenozata

A

1 cm

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24
Q

Fiziopat stenoza aortica

A

Sange in vs=> pres crescuta si volum crescut in vs=»»>
HIPERTROFIE CONCENTRICA COMPENSATORIE( scade stres parietal, scade complianta vs, creste pres de umplere diastolica, creste cons de oxigen)
Hipertrofie as compensatorie
Contractilitatea vs se mentine mult timp(disf sitolica+dilatare)
Gradient anormal vs ao

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25
Simpteome stenoza aortica
Dispnee Angina(creste cons o2 si scade pres din aorta deci scade flux coronarian) pot exista si afectaru coronariane Sincopa de efort Cand exista simptome suprav la 2 ani e 50%
26
Clinic stenoza aortica
Suflu sitolic ejectional mezosistolic si iradiaza la carotide Parvus et tardus(slab ca i pres mica in aorta) Impuls apical crescut(ca i hipertrofie) Z4 intarit(ca se contracta puternic atriul) Z2 unic sau dedublat paradoxal(z2=aortic+pulm deci cand ai stenoza se prelungeste ejectia astfel incat poate sa depaseasca sau sa se suprapuna)
27
Paraclinic stenoza aorta
Ekg hvs si repolarizare Rx hvs si dilatatie aorta poststenotica(flux turbulent care dilata) Eco: ingrosare, calcificari, bucuspidie Velocitate jet sitolic+gradient pres vs ao(bernouli) pt gradul regurgitarii>40 mmhge severa Suprafata(ec de continuitate) Hvs, fe, fct diastola Cateterism gradient pres Test de efort NU Dopler velocitatea fluxului prin valva>4ms grav
28
Criterii severitate strnoza aortica
``` Simptome Durata suflu sistolic Sa muta(valve calcificate) Supr <1cm Grad pres mediu >40 Velocitate >4 ```
29
Stenoza aortica low flow low gradient
Fe redusa, vs dilatat(ca o cmd) S<1cm Gradient <40mmhg (Chir ca e severa pare ca i severa daca te iei dupa gradient) Ca sa i maresc fe(gen volumul bataie) pt scurt timp pt a verifica ii fac TEST CU DOBUTAMINA(creste contractikitate si gradient) daca creste gradientul ins ca chiar e sever Suflul e mai slab
30
Stenoza aortica paradoxal low flow low volume
Fe normala Gradientul e mic ptc vs e mic Gen la batrani hvs concentruca severa
31
Daca e o st aortica severa cu fe mica operez?
Nu ca nu suporta op Mortalitatea mare E bun candidat pt tavi
32
Tratament st aortica
Progreseaza 0,5 cm pe an S a incercat statina dar meh Nu sport Diuretic, ieca, digitala, NU BETABLOC(scad inotropismu dar cu grija daca vr pt angina) Proteze mecanice sau biologice Autogrefa pulmonara
33
Valvuloplastie percutana
Dilatare cu balon Putin eficace la st aortica dar f buna la st mitrala Bridge to surgery Pac inoperabili Pac tineri fara calcificari(st aortica congrnitala, raa) Nu sch cursul natural al bolii
34
Tavi
Dilat cu balon | Dar bag un fel de stent si in interior o valva
35
Indicatii tavi
``` Risc chirurgical crescut(euroscore 2) Diverse comorbiditati, fragili Pacienti >75 ani Cu antecedente de chir cardiaca Cu morfologie a valvei si a aortei favorabila! Si abord femural posibil ```
36
Contraindicatii tavi
Inexistenta echipa Inel airtic dimensiuni nepotrivite Distanta prea mica intre inel si coronare Endocardita Trombi in vs Bicuspidie aortica Boala coronariana care necesita interventie
37
Stenoza mitrala etiologie
Raa Congenital Calcificare inel mitral extinsa la valva Simulata de mixom, vegetatii mari
38
Stenoza mitrala anatomopat
Fibroza si calcificare foite valvulare Fuziune comisuri valvulare Fibroza si scurare cordaje
39
Supraf normala v mirrala
4-6 Sub 2 e semnif hemodinamic Vm capata forma de palnie prin fuziune
40
Fizpat stenoza mitrala
``` Creste pres as Creste pres vene si capilare Transudat interstitiu si alveole Dispnee Se desch colateralele intre venele pulm si bronsice HEMOPOTIZIE ``` Creste pasiv pres art pulm=>hipertrofie medie si fibroza intima=> creste rez arteriolar=> creste pres vd=>hipertrofie dilatatie icd Htp Prin cresterea pres in as=> fia Stagnare sange prin fia=> embolie
41
Clinic stenoza mitrala
Asimpt Dispnee(efort, repaus, ortopnee, dispn paroxistica nocturna) Icd Fia, tep, endocardita, hemoptizie
42
Clinic st mitrala
Impuls vd crescut Z1 intarit(la vm mobila, dispare in stadii avansate) ACMENT DE DESCHIDERE! URUITURA DIASTOLICA poate asocia reg mitrala, tricuspidiana, pulm, aortica 1:55=>>>
43
Putem interveni la asimptomatici valvulopatii?
Da daca au semne de progn prost gen fe super mic sau ventr dilatat
44
Pres artera pulm calcul
Rrgurgitrarea tricuspidiana P=4v la a 2 P+pad=pap
45
Ce valva se imdexeaza la copr
Aorta
46
Sa am grija la hta pac cand auscult pacientul. Dc?
Severitatea reg mitrala!
47
Ceva ce n am inteles legat de reg mitr
Creste pres in vs daca cresc rvp Ma gandeam ca creste postsarcina Deci da poate d asta
48
Fe supranormala cand si dc?
Reg mitrala Ptc E mai putin sange de ejectat deci il da afara mai usor Si in plus POSTSARCINA E MAI MICA PTC DEBITUL E SCAZUT
49
Reg mitrala cronica cum sunt presiunile si ce se intampla
Pai pres oulmonara e normala ptc atriul s a dilatat si e compliant Problema e ch debitul anterograg f mic
50
Dc am dispnee la reg mitr
In primul rand in acut e epa cu congestie In cronic fie la fresterea presiunilor fie la disfuntia contractila vs Daca continua atunci pres crsscuta se transmite si in artera pulm=> semne de insuf dr!!
51
Dg dif regurgitrare mitrala
``` Stenoza aortica(inteleg si ca aortica se aude la mag stanga a sternului si focarul aortei) Fac ausc dinamica deci il pun sa faca efort izometric=>acc ref mirrala ```
52
Eco rm
As si vs dilatate Fe Vena contracta=grosimea jetului la originea lui>7mm e sever-zona cea mai ingusta a jetului
53
Tratament reg mitr
Acut: nitroprusiat si diuretic Cronic: bb si spironolactona pt ic Reparare mai ales la tineri Protezare cu cordaje Protezare standard fara cardoaje(daca fe eok) Transcateter margine la margine
54
Cand operez o reg mirrala
La simptome Cand fe e nuca, pap>50, diaam sistolic>45 Are fia Vas>69
55
Eco reg aorta
Jet regurgitrare Vena contracta Pressure half time(in cat timp gradientul aovs se unjumatateste) daca i ra usoara e lent daca i sevrra e rapida
56
Criterii severitate r ao
Bruschete aparitie Suflu siatolic(ca ins ca e mare vol reg) Z3(deci vs e dilatat) Suflu protodiastolic descrescento acut Vs sistolic>59 Fe<55 Gradient r ra
57
Cand operez r ao
Simpt Vs<50 Dilatate mare vs Cum? Repar valva cu anuloplastie la tineri cuvtricuspida supla Inlocuiesc anevrismul>55 >50 daca are bicuspidie sau marfan >45 la marfan nasoa, loeys (Adica pe scurt proteza valvulara+valva inclusa) Sau pui proteza mecanica sau biologica Aotogrefa ross
58
Xare e cea mai frecv valvulop
Stenoza aortica
59
Fiziopat stenoza aortica
``` Creste ores vs HIPERTROFIE CONCENTRICA(scade stres parietal, scade complianta vs=> creste pres de umplere diastola, creste consum o2) ``` HIPERTROFIE ASTRIU STANG GRADIENT ANORMAL INTRE VS SI AO(mare mic) Daca apare fia=> scade f mult contractilitatea Mrg la final e o disf sist si diast (un vs dilatat pana la urma)
60
Clinic stenoza aortica
Dispnee Angina(creste consum, scade flux, afectare coronara) Sincopa la efort (nu poate asigura debit si oricum e vasodil la efort deci scade presarcina) in repaus:aritmii
61
Clinic stenoza aortica
Suflu mezosistolic ejectional iradiat carotine Ouls parvus et tardus Impuls palpabil Zg 4 Zg2 unuc sau dedublat paradoxal
62
Rx tenoza aorta
N are trb cu plamanii Are dulatatie de aorta poststenotica Hvs
63
Cataterism fradient presiune
Partea hasurata intre p vs si pao
64
Eco st aorta a zis profa ca
E un mod f bun de ev a presiunii din sistola
65
Criterii gravitate st airta
``` Simptome Durata suflu Sa muta! <1cm diam Grad pres >40 Velocitate >4 ```
66
Sao low flow low gradient
``` Va dilatat cu fe redusa S<1cm Suflu slab Dar gradient mic Ptc daca fe e mica=> fluxul e mic=> nu ajunge la gradient ``` Ca sa vad daca asta e situatia asta trb sa i maresc fe sau volum bataie Fac TEST CU DOBUTAMINA daca creste ins ca e st aortica severa Daca nu creste fradientul atuncu poate are st aortica medie si cmd
67
Sao paradoxal low flow low volume
``` Fe normala Dar oaradoxal e gradient mic Dc? Ptc ventriculul e mic Hvs concentruca cu volum f mic=>volum bataie mic N am ce examen sa fac ```
68
Daca fe e 28% si stenoza aortica e severa e operabil?
Nu | Poate tavi
69
Trat chir st aorta
Valvuloplastie nu prea Proteze Tavi-transcateter aortic valve implantation
70
Cui fac tavi
``` Risc chir crescut Cu comorbiditati Peste 75 Cu interventii cardiace antecedente Cu morfo valva si fadacina aorta bune si abord femural posibil ```
71
Contraindicatii tabi
``` N au echipa Tromb in vs Inel airtic <18 sau >29 Dist mica untre aorta si coronarea Endocardita Bicuspidie Boala coronara carr necesita revasc ```
72
Supraf normala mirrala
4-6 Sub 2 nasol Palnie
73
Simptom caract stenoza mitrala
Hemoptizie!
74
Fizpat st mitr
Practic 2 varinte Fue face epa si hemoptizie Fie care htp si are tot ingrosat pe acolo deci face icd Fia prim intindere as
75
Clinic st mitrala
Dispnee Icd (Fia, tep? Endocardita, hemoptizie)
76
Semne icd
Vene jugulare Reglux abdominojugulaascita Edeme perif
77
Clinic st mitr
Impuls vdmz1 intarit CLACMENT DESCHIDERE URIITURA DIASTOLICA
78
Rx st mitrala
``` Multa trb cu epa Arc mijlociu bombat Hipertrofie urechiusa sf Had Artera oulm dil ```
79
Eco mod m st mitr
Aia cu fusiunile
80
Complicatii st mitr
Fia Embolii Endocardita Hemoptizii
81
St mitr chir
Comisuritomie percutana cu balon Comisuritonia chir Protezare

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