lec of medicine

2. The heart
 The heart has four chambers - two atria and two ventricles
 Heartbeat both of the atria contract first to pump blood into
the ventricles
 Then both ventricles contract to pump blood out of the
heart into the arteries
 There are one-way valves between the atria and ventricles,
and also between the ventricles and the large arteries that take
blood from the heart

6. 5 cm2

8. Mitral valve stenosis
Narrowing of the heart's mitral valve. This abnormal valve
doesn't open properly.
 The valve leaflet may become fused or
thickened that the valve can not open freely
Obstruct the flow of the blood
More stress in the left atrium Heavy work
Hypertrophy and dilation of the myocardium Heart
failure

10. Symptoms
There are no symotom untill th orifce has an area of 2 cm2.
• Shortness of breath, especially with exertion or when
laying down
• Fatigue, especially during increased physical activity
• Swollen feet or legs
• Heart palpitations :sensations of a rapid, fluttering
heartbeat
• Dizziness or fainting
• Heavy coughing, sometimes with blood-tinged sputum
• Chest discomfort or chest pain
• Severe headache
• Trouble speaking or other symptoms of stroke

11. Diagnosis
Investegations
 Chest X-ray
Heart chamber enlargement
Condition of the lungs
.
It shows small heart with enlarged left atrium

12. • Electrocardiogram (ECG)
• Echocardiogram
1. Transthoracic echocardiogram.
To confirm the diagnosisof mitral stenosis
.It shows the size and function of the chambers.
2. Transesophageal echocardiogram.
The device is inserted down in to the esophagus allows
a close look at the mitral valve does

13. • Cardiac catheterization
 Invasive technique
Threading a thin tube (catheter) through a blood
vessel in the arm or groin to an artery in the heart
 Injecting dye through the catheter to make the artery
visible on an X-ray.

14. Treatments
• Medications
Diuretics to reduce fluid accumulation in the lungs or
elsewhere.
Blood thinners (anticoagulants) to help prevent blood
clots. A daily aspirin may be included.
Beta blockers or calcium channel blockers to slow the
heart rate
Anti-arrhythmics(Digoxin) to treat atrial fibrillation
Antibiotics to prevent a recurrence of rheumatic fever

15.  Procedures
• Repair with balloon valvuloplasty
 Mitral valve surgery
• Commissurotomy
open-heart surgery to remove calcium deposits and other
scar tissue to clear the valve passageway
• Mitral valve replacement
Mechanical valves, Made from metal, are durable but
carry the risk of blood clots forming. need to take an
anticoagulant
Tissue valves: which may come from a pig, cow or human

16.  The valve does not close properly
 Blood to leak back (regurgitate) into the left
atrium when the left ventricle contracts
Mitral regurgitation

17. Causes of mitral regurgitation
 The valve is weakened(supporting tissue)
 Damaged (scar).

18. • Degenerative changes
 The most common cause.
 The tissues which connect the mitral valves to the
heart wall can become weak and stretched over time,
which results in the valves not shutting together properly.
• Rheumatic heart disease

19. • Symptom
• Dyspnea (Shortness of breath with exertion), which may
later develop into shortness of breath at rest and at night.
• Fatigue and weakness.
• Odema /Fluid buildup in the legs and feet.
• Heart palpitations, if atrial fibrillation develops

20. Treatment
• Monitoring the heart function and symptoms
•Treating symptoms as they develop

23. Causes
 Congenital aortic stenosis
Bicuspid aortic valve, has two flaps instead of the usual 3
Blood flow across the bicuspid valves is more turbulent,
causing increased wear and tear on the valve leaflets.
Calcification, scarring, and reduced mobility of the valve
leaflets

24.  Acquired aortic stenosis
 Rheumatic fever
Aging , Calcific aortic stenosis
Atherosclerosis in the arteries of the heart

25. The major symptoms of aortic stenosis
 Chest pain (angina) :Lack of oxygen in the
heart
 Fainting (syncope)
 Shortness of breath (due to heart failure

26. Diagnosis
 Electrocardiogram
Chest X-ray
 Echocardiography
 Cardiac catheterization

27. •Patients with moderate aortic stenosis (valve area 1.5 to1.0
square centimeters) are advised to avoid strenuous activities
such as weight lifting or runing
• Aortic stenosis can progress over a few years. Therefore,
patients are usually examined annually
• Since valve infection (endocarditis) is a serious
complication of aortic stenosis, these patients are usually
given antibiotics Prophylaxi
• Diuretics to reduce high lung pressures and remove lung
fluid

28.  The aortic valve area can be opened or enlarged
with a balloon catheter (balloon valvuloplasty)
If severe aortic stenosis is confirmed, aortic valve
replacement
 Recently, aortic valves from human cadavers

30. Aortic regurgitation
 Dyspnea oexertion,
 Orthopnea
 Paroxysmal nocturnal dyspnea.
Palpitations
Angina pectoris
Cyanosis
Circulatory shock

31. Diagnostic evaluation
 Echocardiography
 Chest X-ray
 ECG
Catheterization

32. Treatment
1. Medical treatment
• Vasodilators
• Low sodium diet, diuretics, digoxin, calcium
blockers and avoiding very strenuous activity
•Antibiotics for endocarditis prophylaxis before dental
procedures

33. Intervention
 Valvuloplasty
 Valve replacement