小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 劳力性呼吸困难
- 运动耐量下降
- 下肢水肿
- 全收缩期杂音
其他诊断因素
- 疲劳
- 最大搏动的移位点
- 端坐呼吸
- 阵发性夜间呼吸困难
- 心悸
- 发汗
- 肺动脉瓣关闭音大于主动脉瓣关闭音
- S3 心音
- S1 心音减弱
危险因素
- 二尖瓣脱垂
- 风湿性心脏病病史
- 感染性心内膜炎
- 心脏创伤史
- 心肌梗死病史
- 先天性心脏病病史
- 缺血性心脏病病史
- 左室收缩功能障碍
- 肥厚型心肌病
- 食欲抑制剂/多巴胺能药物
- 收缩压升高
诊断性检查
首要检查
- 经胸超声心动图
- 心电图 (ECG)
需考虑的检查
- 血流会聚法或近端等速表面积
- 彩色多普勒血流
- 经食管超声心动图
- 心导管检查
- 心脏磁共振成像（CMR）
治疗流程
急性重度 MR
慢性重度原发性 MR：无症状
慢性原发性 MR：有症状
慢性重度继发性 MR
撰稿人
作者
Prakash P. Punjabi, FRCS, FESC, MS, MCh, FCCP, FFSTEd, Diplomate NBE
Professor
National Heart and Lung Institute
Imperial College London
Consultant Cardiothoracic Surgeon
Department of Cardiothoracic Surgery
Hammersmith Hospital
Imperial College Healthcare NHS Trust
London
UK
利益声明
PPP is an author of references cited in this topic. PPP declares that he has no competing interests.
鸣谢
Dr Prakash P. Punjabi would like to gratefully acknowledge Dr Samir Kapadia and Dr Mehdi H. Shishehbor, previous contributors to this topic.
利益声明
SK and MHS declare that they have no competing interests.
同行评议者
Matthew Czarny, MD
Assistant Professor of Medicine
Department of Cardiovascular Medicine
Johns Hopkins University School of Medicine
Baltimore
MD
利益声明
MC is a co-investigator for several clinical trials for Medtronic and Edwards Lifesciences involving transcatheter valve replacement or repair for the aortic, mitral, and tricuspid valves for which the Johns Hopkins University receives research funding. MC does not receive any direct or indirect support or remuneration for these roles. MC has received travel and accommodation from Abbott, the manufacturer of the MitraClip(TM) transcatheter edge-to-edge repair system, for attending training meetings.
鉴别诊断
- 急性冠脉综合征 (ACS)
- 感染性心内膜炎
- 二尖瓣狭窄
更多 鉴别诊断指南
- 2020 年 ACC/AHA 心脏瓣膜病患者管理指南
- 2021 ESC/EACTS 心脏瓣膜病管理指南
更多 指南
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