主动脉瓣狭窄

最后审阅: 5 九月 2022
最后更新: 16 八月 2022

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
  • 疲劳
  • 胸痛
  • 运动性晕厥
  • 收缩期喷射性杂音
  • 第二心音减弱,呈单心音
  • 颈动脉细迟脉
更多 关键诊断因素

其他诊断因素

  • S2 逆分裂
  • Gallavardin 现象
  • 出血
其他诊断因素

危险因素

  • 年龄 60 岁以上
  • 先天性双瓣膜主动脉瓣
  • 风湿性心脏病
  • 慢性肾病
  • 放疗
  • 低密度脂蛋白(low-density lipoprotein, LDL)胆固醇水平高
  • 高脂蛋白血症
  • 高血压
  • 脂蛋白 (a) 水平升高
更多 危险因素

诊断性检查

首要检查

  • 经胸超声心动图(包括多普勒)
  • 心电图(ECG)
  • 胸部 X 线检查
更多 首要检查

需考虑的检查

  • 心脏磁共振成像
  • 心脏 CT
  • 心导管检查
  • 心电图运动负荷试验
  • 多巴酚丁胺负荷超声
更多 需考虑的检查

治疗流程

初步治疗

临床情况不稳定

急症处理

临床稳定:有症状

临床稳定:无症状

撰稿人

作者

Matthew Czarny, MD

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

利益声明

MZ is a non-funded site co-investigator for the Medtronic trial of transcatheter aortic valve replacement (TAVR) in low surgical risk patients.

Rani Hasan, MD

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

利益声明

RH declares that he has no competing interests.

鸣谢

Dr Matthew Czarny and Dr Rani Hassan would like to gratefully acknowledge Dr Girish L. Kalra and Dr Vasilis Babaliaros, previous contributors to this topic.

利益声明

GLK declares that he has no competing interests. VB is a co-investigator in the PARTNER trial, and he has served as a consultant for Edwards Lifesciences and Abbott Vascular.

同行评议者

Peter Block, MD

Professor of Medicine

Emory University School of Medicine

Atlanta

GA

利益声明

PB declares that he has no competing interests.

Ghada Mikhail, BSc, MD, FRCP

Consultant Cardiologist and Honorary Senior Lecturer

Imperial College Healthcare NHS Trust

Hammersmith Hospital

London

UK

利益声明

GM has been supported by Edwards Lifesciences (manufacturer of the Edwards Sapien Transcatheter Valve) for attending cardiology conferences. Both Edwards Lifesciences and Medtronic (manufacturer of the CoreValve Transcatheter Valve) are contributing to an educational course on the transcatheter and surgical treatments of aortic and mitral valve disease. Edwards Lifesciences are supporting a research project on transcatheter treatment of aortic valve disease.

Juan M. Sztajzel, MD

Consultant

Cardiology Center

University Hospital Geneva

Geneva

Switzerland

利益声明

JMS declares that he has no competing interests.

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