The mitral stenosis (MS) is the narrowing of the Mitralklappenöffnung which impedes the influx of the blood from the LA to the LV. the cause (Fast) is invariably rheumatic fever. Common complications include pulmonary arterial hypertension, atrial fibrillation and thromboembolism. The symptoms are those of heart failure; The findings are an opening signal and a diastolic murmur. The diagnosis is made because of the physical examination and echocardiography. The prognosis is good. Diie medical treatment includes diuretics, beta-blockers or calcium channel blockers frequenzlimitierende and anticoagulants. An effective treatment for severe forms of the disease consists of Ballonkommissurotomie, surgical commissurotomy or valve replacement.

The mitral stenosis (MS) is the narrowing of the Mitralklappenöffnung which impedes the influx of the blood from the LA to the LV. the cause (Fast) is invariably rheumatic fever. Common complications include pulmonary arterial hypertension, atrial fibrillation and thromboembolism. The symptoms are those of heart failure; The findings are an opening signal and a diastolic murmur. The diagnosis is made because of the physical examination and echocardiography. The prognosis is good. Diie medical treatment includes diuretics, beta-blockers or calcium channel blockers frequenzlimitierende and anticoagulants. An effective treatment for severe forms of the disease consists of Ballonkommissurotomie, surgical commissurotomy or valve replacement.

(See also Overview of the heart valve diseases.) The mitral (MS) is the narrowing of the Mitralklappenöffnung which impedes the influx of blood from the LA into the LV. the cause (Fast) is invariably rheumatic fever. Common complications include pulmonary arterial hypertension, atrial fibrillation and thromboembolism. The symptoms are those of heart failure; The findings are an opening signal and a diastolic murmur. The diagnosis is made because of the physical examination and echocardiography. The prognosis is good. Diie medical treatment includes diuretics, beta-blockers or calcium channel blockers frequenzlimitierende and anticoagulants. An effective treatment for severe forms of the disease consists of Ballonkommissurotomie, surgical commissurotomy or valve replacement. In mitral stenosis, the Mitralkappensegel thicken and become immobile and Mitralklappenöffnung is by the fusion of the commissures and shortened, narrowed thickened and caked chordae tendinae. The most common cause is rheumatic fever, although many patients the disease are not even aware. Among the very rare causes include Mitralkranzverkalkungen with calcification extensions to the valve leaflets, making them stiffen and do not open fully. Occasionally, an MS is innate. If the flap can not close completely, can simultaneously be a mitral insufficiency (MI). In patients with rheumatic fever caused by MS lesions and the aortic or tricuspid valve, or both may be present. The size of the LA and the pressure progressively increase, to compensate for the MS; the pulmonary venous and capillary pressure also increases and can cause a secondary pulmonary hypertension, which may lead to right ventricular failure, heart failure and tricuspid and pulmonary valve. The rate of progression varies. The enlargement of the LA predisposed to atrial fibrillation, a risk factor for thromboembolism. The faster heart rate and loss of atrial contraction at the beginning of VHF often lead to sudden worsening of symptoms. Symptoms and signs Symptoms of mitral stenosis correlate poorly with the severity of the disease, as the disease progresses slowly and often unconsciously limit the patient their activity. Many patients are asymptomatic until they become pregnant or atrial fibrillation developed. The initial symptoms are usually the heart failure (z. B. exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue). The symptoms typically do not begin before the year 15th to 40th after an episode of rheumatic fever. In developing countries, younger children may become symptomatic because streptococcal infections may not be treated with antibiotics and recurrent infections are common. A paroxysmal or chronic atrial fibrillation further reduces the blood flow into the left ventricle (LV), and calls a pulmonary edema and acute dyspnea produced when the ventricular heart rate is poorly controlled. VHF can also cause palpitations. With up to 15% of patients nichtantikoagulierten it causes systemic embolism with symptoms of a stroke or ischemia in other organs. Less common symptoms include hemoptysis due to the rupture of small pulmonary vessels and pulmonary edema, v. a. during pregnancy, when the blood volume increases. Hoarseness due to compression of the left recurrent laryngeal nerve by a dilated LA or pulmonary artery (Ortner’s syndrome) and symptoms of pulmonary hypertension and RV failure may also occur. The mitral stenosis can cause signs of pulmonary heart disease. The classic expression in MI, a plum-colored flush of the cheeks, only occurs when cardiac output is low and the pulmonary hypertension is difficult; the causes are cutaneous vasodilation and chronic hypoxemia. Occasionally, the first symptoms and discomfort of MS are those of an embolic event as such. As a stroke. Endocarditis rarely occurs in MS, unless there is also a MI present. Palpation On palpation palpable 1st and 2nd heartbeat can be detected (S1 and S2). S1 is best palpated at the apex and S2 at the upper left Sternumgrenze. Pulmonary component of S2 (P2) is responsible for the pulse and is caused by the pulmonary hypertension. An RV pulse (lifting) is palpated at the left Sternumgrenze and can accompany advanced jugular veins, if a pulmonary arterial hypertension is present and diastolic RV dysfunction entwickelt.Auskultation Auscultatory findings are a loud S1 caused by the closing of the sail abruptly stenotic mitral valve (M1); which is best heard at the apex. S1 may be missing if the heart valve is heavily calcified and immobile. can also be heard because of pulmonary arterial hypertension, a normally split S2 with reinforced P2. Most striking is an early diastolic Mitralklappenöffnungston that arises when the sails bulge in the LV, and is loudest near the lower left Sternumgrenze; it is followed by a low frequency rumbling diastolic decrescendo crescendo noise that is best heard with the hopper of the stethoscope at the apex during the end-expiration (or above the palpable heart’s apex) when the patient is in a left lateral position. The opening signal may be weak or absent when the mitral valve is calcified. The Mitralklappenöffnungston moves closer to S2 zoom (longer duration of the noise), when the mitral stenosis is severe, and the pressure in the left atrium increases. The diastolic murmur takes after a Valsalva maneuver (when the blood flows into the LA), after exercise and maneuvers that increase the afterload (z. B. in the squatting position and the isometric handgrip) to. The noise may be quieter or missing when an enlarged RV shifts the LV back and when other diseases (pulmonary hypertension, right-sided valve disorders, atrial fibrillation with rapid ventricular rate) reduce blood flow through the mitral valve. The presystolic Crescendo is caused by an increased flow of blood in the atrial contraction. However, the closing of the mitral valve leaflets during LV contraction can also contribute to this finding; but only at the end of a short diastole, when the LA pressure is still high. Prominent mitral-NOISE with präsystolischer accent, is described as a “growl” and “barking”. Mitral-noises rumbled in general and niedrigfrequent and crescendo during diastole. var player panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘player..’); ko.applyBindings ({MediaUrl ‘/-/media/manual/professional/sounds/mitral_stenosis_murmur_de.mp3?la=de&thn=0&mw=350’, Mime Type: ‘audio / wav’}, playerPanel.get (0)); Mitral-sound recording provided by Jules Constant, M.D. The intensity of the sound of a mitral varies with the length of the cardiac cycles. In this example, atrial fibrillation, the intensity of the noise increases with longer cycles and shorter cycles off because the current flowing through the mitral valve blood volume changes. Overall, the intensity decreases because the atrial contraction disappears. var player panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘player..’); ko.applyBindings ({MediaUrl ‘/-/media/manual/professional/sounds/mitral_stenosis_atrial_fibrillation_de.mp3?la=de&thn=0&mw=350’, Mime Type: ‘audio / wav’}, playerPanel.get (0)); Mitral provided in atrial fibrillation inclusion of Jules Constant, M.D. Diastolic murmurs that can coexist with the sound in MS include: Early diastolic murmur of coexisting aortic insufficiency (AI) that can be directed to tip Graham Steell murmur (best heard that along the left Sternumrandes a bright diastolic Crescendogeräusch, and is caused by pulmonary regurgitation secondary to pulmonary hypertension) diastolic flow noise in severe MI blockade by left atrial myxoma or Kugelthrombus (rare) the example shows the typical features of a mitral the Geräuscht is rumbling or niedrigfrequent and starts early on in diastole with Crescendo S2. var player panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘player..’); ko.applyBindings ({MediaUrl ‘/-/media/manual/professional/sounds/mitral_stenosis_de.mp3?la=de&thn=0&mw=350’, Mime Type: ‘audio / wav’}, playerPanel.get (0)); Mitral recording provided by Jules Constant, M.D. Diagnostic echocardiography Diagnosis is suspected clinically and confirmed by echocardiography. Typically, the 2-dimensional echocardiography shows abnormalities of the mitral valve and the subvalvular structures. It also provides information about the degree of calcification of the valve, the stenosis and the size of the LA. The Doppler echocardiography provides information on the transvalvular gradient and pulmonary artery pressure. The normal valve area of ??the mitral valve is 4-5 cm2. The severity is marked as echocardiography Moderate: 1.5-2.5 flap surface cm2 Severe: damper area <1.5 cm 2; Symptoms are often available Very difficult: damper area <1.0 cm 2 However, the relationship between the size of the valve opening and the symptoms is not always uniform. Using the color-coded Doppler echocardiography an associated MI can be detected. The transesophageal echocardiography can be used to detect or rule out small atrial thrombi, especially in thrombus in the left atrial appendage, which normally can not be seen transthoracic. Mitral echocardiogram provided by Paul Tanser, M.D. var model = {videoId: '4543027098001', playerId 'SyAEZ6ptl_default', imageUrl 'http://f1.media.brightcove.com/8/3850378299001/3850378299001_4543079922001_vs-56168f04e4b056245bfda449-672293877001.jpg?pubId=3850378299001&videoId=4543027098001' title: 'mitral' description ' u003Ca id = "v38401570 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eZweidimensionales echocardiogram

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