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Cardiology > Valvulopatii Mitrale > Flashcards

Valvulopatii Mitrale Flashcards

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?

A

Severitatea stenozei mitrale

25
Q

Ce se poate vedea pe ETE si in ce caz se face pt SM?

A

-detctare tromb AS
-evaluarea acurata a morfol vv mitrale
Pt evaluarea vv inainte de interv chir sau de comisurotomie percutana

26
Q

Cand folosim catetrism cardiac in SM?

A

La pacientii cu ind de corectie a stenozei vv m.

27
Q

Ce trat medic se adm pt SM?

A

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
Q

Este SM tratabila medicamentos?

A

Nu. Se trat medic complicatiile

29
Q

Ce este comisurotomia percutana mitrala si ce ci are?

A

=separare comisuri prin umflare balon la pacienti simptomatici
CI:
-SM stransa
-RM>usoara
-calcific severe
-sten Ao stransa

30
Q

Ce trat chirugic se face in SM?

A
  1. Comisurotomia mitrala pe cord deschis/ inchis (Valvulotomia)
  2. Protezare mitrala- proteza biologica/mecanica
31
Q

Care sunt diferentele intre vvtomie pe cord inchis/deschis in SM?

A

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
Q

In ce cazuri e necesara protezarea vv in SM?

A
  1. SM +RM
  2. Afect vv severa/ calcific vv care impiedica corectie fara a provoca RM
  3. SM severa+ tromboza AS
33
Q

Ce durabilitate au protezele vv?

A

20 ani

34
Q

In cazul caror proteze e necesar trat anticoag in SM?

A

Mecanice

35
Q

Ce este Regurgitarea Mitrala (RM)/Insuf mitrala?

A

=inchiderea imperfecta a cuspelor care nu se pot apropia => sg se intoarce din VS in AS

36
Q

Care sunt cele mai frecv cauze de RM?

A

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
Q

Care sunt cauzele RM acute?

A

Ichemie
IMA
Traumatisme

38
Q

Care este mecanismul fiziopat in RM acuta?

A

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
Q

Care este mec fiziopat in RM cronica?

A

AS dilat cu p crescuta -»> CPC-> HTP postcapilar -> HTP precapilar -» HTP mixta => IVD

VS supraincarcat, diastola -» Htrof -» dilat -» IVS

40
Q

Ce este RM mută?

A

=RM cronica severa cu hn VS sever deprimat => nu se aude nimic la apex

41
Q

Ce simptome apar in RM acuta? Dar in cronica?

A

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
Q

De ce apare dispnee/ortopnee in RM?

A

Disfunctie vv -» creste p in AS -» HTP -» EPA

43
Q

De ce apare fatigabilitate in RM?

A

Scaderii Debit cardiac

44
Q

Care este consecinta cea mai severa in RM?

A

Cardiomiopatia dilatativa

45
Q

Ce se poate obs la inspectia si palpare in RM?

A

Inspectie: ca la insuf
Palpare: soc apexian deplasat in lateral (stg) si accentuat difuz + freamat sistolic

46
Q

Ce se aude la auscultatia cordului in RM?

A

Zg1 diminuat
Suflu sistolic la apex
Clic mezositolic (in mixedem)
Zg 2 dedublat
Zg3 accentuat = uruitura diastolica
Zg4

47
Q

Cum este suflul din RM?

A

-holosistolic
-la apex cu iradiere in axila
-caracter in jet de vapori

48
Q

Ce examinari complemenetare se fac in RM?

A
  1. Rx
  2. EKG
  3. Ecocardio: ETE
  4. Cateterism cardiac
49
Q

Ce se evidentiaza pe RX in RM?

A

-dilat AS
-dilat VS
-calcific vv

50
Q

Ce se obs la EKG in RM?

A

-unda P bifida/mitral (suprasolicitare atriala)
-HVS: R inalt in DI, V6 si S adanci in V1, V2
-FiA

51
Q

Ce se evidentiaza la Ecocardiografie in RM?

A

-dilat AS, VS
-ruptura de cordaje/m papilari
-functia VS

52
Q

Cu ce examinare putem aprecia severitatea RM?

A

Ecocardio Doppler color

53
Q

Ce se evidentiaza pe ETE in RM?

A

Anomalii str ale vv pt pregatire operatorie

54
Q

Ce tratament se adm in RM acuta?

A

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
Q

Ce trat se adm in RM cronica?

A

Ameliorare simptome:
-IECA
-diuretice
-vasodilatator
-beta-blocant
-digoxin
-anticoag orale (ACO)

56
Q

Ce ACO e Ci in stenoza mitrala?

A

NOAC

57
Q

Ce se poate face chirurgical in RM severa?

A

MitraClip

58
Q

Cum se trat RM funcțională?

A

Terapie de resincronizare cardiaca

Cardiology (10 decks)

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