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Valvulopatii Mitrale Flashcards

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1
Q

Din ce este format ap vv MITRAL?

A
  1. Inel fibros
  2. 2 cuspe: ant si post
  3. Cordaje tendinoase
  4. Muschii Papilari
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2
Q

Care sunt cauzele in ordinea frecventei de Stenoza Mitrala (SM)?

A
  1. Reumatismala: RAA
  2. Degenerativa: -la varstnici prin calcificare inel mitral
    -la cei cu HTA, BCR, DZ (frecv femei varstnice)
  3. Congenitala
  4. Dobandita+ defect septal atrial => SD Lutembacher
  5. Tumori carcinoide cu metastaze pulmn/ primare bronsice
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3
Q

Care e mecanismul SM reumatismale?

A

Infectia cu Strept beta-hemolitic de grup A-> RAA-> inflamatia -» fuziune comisuri, reducere arie orif vv=> deschidere in dom-»>ani-» ingrosare vv-» fuzioneaza cuspele-> depozite de calciu -» imobilizare cuspe -» SM

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4
Q

Ce se intampla fiziopat la niv inimii datorita SM?

A

SM-> creste pAS-> AS hipertrof -» dilata -» creste pres pulmn -> HTP + FiA (pierderea contractilit AS) -» 1. HVD -» dilat VD -» insuf tricusp-» IVD -> congestie sistemica -»»> ICC

                                                                   2. EPA
                                                                   3. Trombi -> embolii sistemi.
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5
Q

Care este aria normala a orificiului mitral si de la ce valoare apar simptome?

A

N: 4-6 cm2
Simptome <2 cm2

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6
Q

Care sunt simptomele si semnele SM?

A
  1. Dispnee importanta
  2. Tuse productiva spumoasa cu striuri sangvinolente -> Hemoptizie
  3. Slabiciune, Fatigabilitate
  4. Edeme mb inf -» Anasarca
  5. Palpitatii
  6. Evenimente embolice
  7. Hepatomegalie -> dureri abd
  8. Disfonie
  9. Jugulare turgescente
  10. Cianoza periferica
  11. Casexie
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7
Q

Care este explicatia Dispneei? In SM

A

Creste p AS -> creste p in vene pulmon-» HTP -> congestie pulmn -» EPA -» alveole pline cu lichid -» nu mai poate respira

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8
Q

De ce apar edemele la mb inf, abd? In SM

A

Creste p AS -» HTP -» ICD -» staza venoasa -» edeme mb inf si abd

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9
Q

De ce apar fatigabilitatea, slabiciunea?In SM

A

Creste p AS -» HTP -» ICD -» staza venoaza -» scadere debit cardiac -» celulele nu sunt oxigenate la timp -» oboseala

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10
Q

De ce apare apar palpitatiile? In SM

A

Dilat AS -> scade contractilitate lui -» inima incearca sa compenseze => FiA -» Palpitatii

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11
Q

De ce apar următoarele simptome in SM: hepatomegalie, edeme, jugulare turgescente?

A

Datorita ICD -> HT Portala

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12
Q

De ce apare disfonia in SM?

A

Datorita Htrof AS care comprima nerv laringeu recurent.

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13
Q

Ce semne apar la inspectie in SM?

A

Facies Mitral=flush malar, pete rosii/cianotice la niv pometilor datorita stazei vasculare <= HTP
Edeme <= ICD
Jugulare Turgescente <= ICD
Cianoza perif <= ICD

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14
Q

Ce poate det FiA din SM?

A

Embolii sistemice

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15
Q

Ce semne apar la Palpare in SM? Cum e pulsul?

A

Palpare: pulsatie ampla parasternal stg=Zg1
Soc apexian: localizat
Puls cu amplitudine redusa initial regulat -> neregulat -»»> FiA

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16
Q

Ce caracteristici sunt presenta la auscultatia cordului in SM?

A
  1. Intarirea Zg1
  2. Dedublare Zg2 (creste P2 adica componenta pulmn a Zg2 datorita HTP)
  3. Uruitura diastolica la apex
  4. Clacment de deschidere a mitralei
  5. Suflu Graham-Steel in aria pulmn <= HTP
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17
Q

Ce caracteristici are uruitura diastolica din SM?

A

=suflu mezoDiastolic
-tonalitate joasa
-in expir

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18
Q

Ce fel de suflu este Graham-Steel din SM? Si de ce apare?

A

Distolic
-HTP -> regurgitare pulmonara

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19
Q

Ce examinari paraclinice se vor realiza in SM?

A

1.EKG
2.Rx
3.Ecocardio TT
4.ETE
5.Ecocardio 2D
6.Cateterism cardiac

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20
Q

Ce se va evidentia la Rx toracică in SM?

A

-Dilat AS
-Contur dublat al arc inf dr
-vv calcificata innstadii avansate in Rx de profil
-mdif circ pulmn: congestii, dilat Artere pulmn -vvpatie severa

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21
Q

Ce se observa la EKG in SM?

A
  1. Unda P bifida=P mitral in dII si v1 la un ritm sinusal
  2. FiA
  3. HVD (deviatie ax dr, R inalt in v1)
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22
Q

De ce apare P mitral pe EKG in SM?

A

Datorita activarii intarziate a AS

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23
Q

Ce prezinta ETT in SM?

A

-dimensiunile AS
-ingrosarea, grad calcificare, mobilitate vv m
-grad fuziune comisurala

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24
Q

Ce prezinta Ecocardio 2D in SM?

Study These Flashcards
A

Severitatea stenozei mitrale

25
Ce se poate vedea pe ETE si in ce caz se face pt SM?
-detctare tromb AS -evaluarea acurata a morfol vv mitrale Pt evaluarea vv inainte de interv chir sau de comisurotomie percutana
26
Cand folosim catetrism cardiac in SM?
La pacientii cu ind de corectie a stenozei vv m.
27
Ce trat medic se adm pt SM?
1.Digoxin 2. Beta-bloc pt FiA 3. Diuretice-in doza mica pt dispnee 4. BCC nonDHP 5. Anticoag: acenocumarol, trombostop pt prev evenim trombembolice 6. Anticoag + cardioversie pt FiA
28
Este SM tratabila medicamentos?
Nu. Se trat medic complicatiile
29
Ce este comisurotomia percutana mitrala si ce ci are?
=separare comisuri prin umflare balon la pacienti simptomatici CI: -SM stransa -RM>usoara -calcific severe -sten Ao stransa
30
Ce trat chirugic se face in SM?
1. Comisurotomia mitrala pe cord deschis/ inchis (Valvulotomia) 2. Protezare mitrala- proteza biologica/mecanica
31
Care sunt diferentele intre vvtomie pe cord inchis/deschis in SM?
Inchis: pacienti cu vv mobile, fara calcificari. Nu necesita bypass cardiopulmn. Rezista 10 ani Deschis: chirurgul vede clar vv. E necesar bypass. Scade riscul regurgit mitrale.
32
In ce cazuri e necesara protezarea vv in SM?
1. SM +RM 2. Afect vv severa/ calcific vv care impiedica corectie fara a provoca RM 3. SM severa+ tromboza AS
33
Ce durabilitate au protezele vv?
20 ani
34
In cazul caror proteze e necesar trat anticoag in SM?
Mecanice
35
Ce este Regurgitarea Mitrala (RM)/Insuf mitrala?
=inchiderea imperfecta a cuspelor care nu se pot apropia => sg se intoarce din VS in AS
36
Care sunt cele mai frecv cauze de RM?
Cauze: Organice: modif vv: afectare degenerativa, mixedematoasa, boala cardiaca ischemica, afect reumatismala, EI, boli autoimune, boli de colagen Funcționale: vv integre, fctia e afectata: dilat inel (cardiomiopatia dilatativa CMV), disctie muschi pilieri (IM inf), cordaj elongat (prolaps de vv mitr), anumite medicamente si subst
37
Care sunt cauzele RM acute?
Ichemie IMA Traumatisme
38
Care este mecanismul fiziopat in RM acuta?
AS nedilat, necompliant -> creste pAS -> creste p in venele pulmn -> creste p in capil pulmn -> creste p in artere pulmn-> HTA Pulmn->>> EPA VS supraincarcat, necompliant-> creste p telediastolica VS (presarcina)-> scade Dcardiac-> vasoconstrictie perif neuroh -> creste postsarcina-> VS se dilata, Htrof ->> agravare RM
39
Care este mec fiziopat in RM cronica?
AS dilat cu p crescuta ->>> CPC-> HTP postcapilar -> HTP precapilar ->> HTP mixta => IVD VS supraincarcat, diastola ->> Htrof ->> dilat ->> IVS
40
Ce este RM mută?
=RM cronica severa cu hn VS sever deprimat => nu se aude nimic la apex
41
Ce simptome apar in RM acuta? Dar in cronica?
Acuta: 1. EPA 2. Instabilit hemodinamica 3. SD de debit mic Cronica 1. Dispnee de efort+/- Ortopnee 2. Fatigabilitate 3. Palpitatii 4. Casexie 5. Trombembolie 6. Endocardita infectioasa subacuta
42
De ce apare dispnee/ortopnee in RM?
Disfunctie vv ->> creste p in AS ->> HTP ->> EPA
43
De ce apare fatigabilitate in RM?
Scaderii Debit cardiac
44
Care este consecinta cea mai severa in RM?
Cardiomiopatia dilatativa
45
Ce se poate obs la inspectia si palpare in RM?
Inspectie: ca la insuf Palpare: soc apexian deplasat in lateral (stg) si accentuat difuz + freamat sistolic
46
Ce se aude la auscultatia cordului in RM?
Zg1 diminuat Suflu sistolic la apex Clic mezositolic (in mixedem) Zg 2 dedublat Zg3 accentuat = uruitura diastolica Zg4
47
Cum este suflul din RM?
-holosistolic -la apex cu iradiere in axila -caracter in jet de vapori
48
Ce examinari complemenetare se fac in RM?
1. Rx 2. EKG 3. Ecocardio: ETE 4. Cateterism cardiac
49
Ce se evidentiaza pe RX in RM?
-dilat AS -dilat VS -calcific vv
50
Ce se obs la EKG in RM?
-unda P bifida/mitral (suprasolicitare atriala) -HVS: R inalt in DI, V6 si S adanci in V1, V2 -FiA
51
Ce se evidentiaza la Ecocardiografie in RM?
-dilat AS, VS -ruptura de cordaje/m papilari -functia VS
52
Cu ce examinare putem aprecia severitatea RM?
Ecocardio Doppler color
53
Ce se evidentiaza pe ETE in RM?
Anomalii str ale vv pt pregatire operatorie
54
Ce tratament se adm in RM acuta?
Pregatire pt operatie: scadere pre si post sarcina, reechlib hemodinamica: nitroprusiat de Na, nitroglocerina, diuretice iv, dobutamina, balon de contrapulsatie Trat chirurgical: inlocuire vv de urgenta
55
Ce trat se adm in RM cronica?
Ameliorare simptome: -IECA -diuretice -vasodilatator -beta-blocant -digoxin -anticoag orale (ACO)
56
Ce ACO e Ci in stenoza mitrala?
NOAC
57
Ce se poate face chirurgical in RM severa?
MitraClip
58
Cum se trat RM funcțională?
Terapie de resincronizare cardiaca

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