Transcript Chronic valvular disease

Chronic valvular disease
The valves are involved by some kinds of diseases
or the inborn developmental anomaly of valves.
Common causes：Rheumatic heart disease(RHD)
Infective endocarditis
Artherosclerosis(AS)
Diseased region： bicuspid valve (mitral valve ) 、
aortic valve
Main changes：
Two types:valvular stenosis
valvular insufficiency
Function of normal valve
pulmonary
circulation
left atrium
aortic valve
pulmonary
valve
bicuspid valve
right atrium
tricuspid
valve
right
ventricle
left
ventricle
Stenosis and insufficiency
Valvular stenosis
Stenosis is the failure of a valve to open completely.
Reason：valve leaflet change to hard or have lower
elasticcity because of more scar tissue or
calcification
Result：less blood flow into the next cavity of heart
during diastole
Valvular insufficiency
Valvular insufficiency is the failure of a
valve to close completely.
Reason：the area of valve change to small or the
valve leaflet change to long.
Result：back flow or regurgitation of the blood
during systole.
Mitral stenosis
Reason：RHD、SBE。
Valve change to thick、hard,lower elasticity
Fish-mouse
Haemodynamics changes
mitral stenosis——compensatory
hypertrophy of left atrium——congestion
of lung——pulmonary artery
hypertension——congestion of right
ventricle——right heart insufficiency——
congestion of systemic circulation
Clinical features：
The features of congestion of lung and congestion
of systemic circulation:
•Anhelation, cyanosis, pink frothy sputum, mitral
facies.
•Hepatomegaly, splenomegaly,
•Edema of lower extremity
mitral facies
hypoxia
Imageology
The volume of left atrium
and right ventricle
increased
The shape like a pear
(pear-shaped heart )
Mitral incompetence(MI)
MI——compensatory hypertrophy of
left atrium——compensatory
hypertrophy of left ventricle——
congestion of lung——pulmonary artery
hypertension——right heart
insufficiency——congestion of systemic
circulation
Clinical features are same to mitral stenosis
The volume of left atrium and left ventricle
increased (Spherical heart)
Aortic stenosis
Normal aortic
valve
aortic stenosis
Aortic stenosis
Aortic stenosis—cardiac output of left
ventricle decreased --left ventricular
hypertrophy→left ventricle dilatation
Clinical features:angina,
pulse pressure decreased,
congestion of lung
The shape of heart likes a boot
(boot-shaped heart )
Aortic incompetence
Aortic incompetence---back flow of the
blood—left ventricular hypertrophy——
congestion of lung — pulmonary artery
hypertension—congestive heart failure—
—congestion of systemic circulation
Clinical cure
Cardiac valve operation:
Repair or displace one or more valves.
Cardiomyopathy
It is means disease of the heart muscle but the
term was originally coined to restrict its usage to
myocardial disease of unkown cause.
Cardiomyopathy are classified into two broad
groups:
1.Primary Cardiomyopathy
2.Secondary Cardiomyopathy
Primary Cardiomyopathy ：
This is a group of myocardial disease of unkown
cause.
Secondary Cardiomyopathy ：
This is a group of myocardial disease of known
etiologies or having clinical associations.
Primary Cardiomyopathy
It is an independence disease of unkown
cause.It has nothing to do with
hypertension, coronary artery disease and
RHD. The main changes include
hypertrophy of cadiocyte and hyperplasy
of fibrous tissue.It is not an inflammatory
disease.
Three types:
1、Dilated(congestive) cardiomyopathy
2、Hypertrophic cardiomyopathy
3、Restrictive cardiomyopathy
Dilated cardiomyopathy
End-results of various agnogenic cardiomyopathies
Most common type(90%)
Male >Female，age of onset :20-50age
Main futures:
•Highly expand of the cavity of heart
•Cardiac failure
Etiology
•Viral infection
•Excessive drinking
•Pregnancy
•Heredity
•Dysbolism
•Intoxation
Pathological change
Gross appearance：
•Volume increased，weight increased (400750g)。
•Ventricular hypertrophy,all cavities expand,
the thickness of cardiac apex decreased
•The thickness of endocardium increased
The shape of heart likes a ball
Left ventricle dilatation,the cavity expand
Light microscope
：
•Hypertrophy and elongate of Part of cadiocytes.
•Interstitial fibrosis of endocardium and cardiac
muscle
•Sometimes,we can find degeneration of
cadiocyte
Hypertrophic cardiomyopathy
Gross appearance:
•Conspicuous hypertrophy of all ventricles,
cardiac weight increased(double weight)
•The thickness of left ventricular wall increased,
cardiac stenosis.
•Endocardium under the atrioventricular valve
and aortic valve is thickening.
Light microscope
：
•Hypertrophy of Widespread
cadiocyte.
•Cadiocytes arrange chaotic.
•Some fibrosis and scar tissue.
Cadiocytes arrange chaotic
Restrictive cardiomyopathy
Gross appearance ：
Endocardial fibrosis of ventricles,the
endocardium is thickening about 2～3mm, grey or
white.
Endocardial thickening
Light microscope ：
•Fibrosis and hyalinization of endocardium
•Atrophy and degeneration of cardiac
muscle
Distinguishing features of the three types
DCM
HCM
Restrictive
cardiomyopathy
Big cavity
Thin wall
Small cavity
Thick wall
Cardiostenosis
Hypertrophy
Widespread
and
hypertrophy and
degeneration of
degeneration
part cadiocytes
Interstitial fibrosis and scar tissue
Fibrosis and
hyalinization of
endocardium
Nomenclature definition
1.Foam cell
2.CHD
3.subendocardial infarction
4.transmural myocardial infarction
5. Primary granular contracted kidney
6. Hypertensive encephalopathy
7. Aschoff Body
8. Anitschkow cell
9. trichocardia
10. Spherical heart
11. pear-shaped heart
12. boot-shaped heart
Questions
1.Pathologic change of AS
2. Pathologic change of benign hypertension
3. Basic pathological changes of RF
4. Difference between RF and SIE
5. Difference among the three types of cardiomyopathy