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DYSPNOE
PRESENTED BY GROUP:
A2
Scenario 2
2. Internodal pathways
6. Purkinje fibres
5. Right and left
bundle branches
LV
RV
coordinated contraction
a. AP is initiated in the SA node
f. rest b. AP are
conducted
throughout
the atria
• very rapid
e. AP • large cells
spread
through c. Conduction
the slows at
ventricles the AV node
(bottom • small cells
to top)
d. AP travel rapidly
through the branch
bundles
Basic Pathway of Blood Flow
CS
SVC Pulmonary
Right Tricuspid Right
Semilunar
Atrium Valve Ventricle
IVC Valve
Systemic Pulmonary
Capillaries Trunk
Aorta Pulmonary
Arteries
S4 → atrial contraction
Mitral Stenosis: Physical Exam
S1 S2 OS S1
First heart sound (S1) is accentuated and
snapping
Opening snap (OS) after aortic valve closure
Low pitch diastolic rumble at the apex
Pre-systolic accentuation (esp. if in sinus
rhythm)
Common Murmurs and
Timing (click on murmur to play)
Systolic Murmurs
Aortic stenosis
Mitral insufficiency
Mitral valve prolapse
Tricuspid insufficiency
Diastolic Murmurs
Aortic insufficiency
Mitral stenosis
S1 S2 S1
HEART SOUNDS
AUSCULTATION
Radio Imaging for Mitral Stenosis
Electrocardiography
Chest radiograph
Echocardiography
Cardiac catheterization
Treatment and Prevention
Treatment :
Beta blockers or rate-limiting calcium channel antagonist
(verapamil or diltiazem) to slow ventricular rate in AF
Diuretics and sodium restriction
Warfarin for pts with AF and or history of systemic and
pulmonaly emboli
In umcomplicated MS, percutaneous balloon valvuloplasty is the
produce of choice
If not feasible, then open surgical valvotomy
Balloon Mitral valvuloplasty
Prevention:
Follow treatment recommended for conditions that may cause valve disease.
Treat strep infections promptly to prevent rheumatic fever. we should know
the patient’s family history of congenital heart diseases, and heart valve
disease before medical treatment
Mitral stenosis itself often cannot be prevented, but complications can be
prevented. For example, any dental work, including cleaning, and any
invasive procedure, can introduce bacteria into the bloodstream. These
bacteria can infect a damaged mitral valve. Preventive antibiotics before these
procedures will help to decrease the risk for endocarditis.
Taking anticoagulation medication as prescribed is very important because
mitral stenosis tends to produce both cerebral and peripheral emboli (blood
clots in the brain and extremities), which can cause severely disabling and/or
life-threatening complications like stroke.
Cardiac Rehabilitation
The program of cardiac rehabilitation:
Counseling for the patient, helping him or her understand the effects of the
condition and to assist with managing the rehabilitation process.
Introducing a program of physical exercise.
Aiding the patient with some lifestyle changes. The program tries to reduce some of
the risk factors that can contribute to heart disease, such as: high blood pressure,
diabetes, high cholesterol, obesity, inactivity, and smoking.
Offering vocational help to enable the patient to return to work, or find work.
Overall, to help patients lead a normal life once more.
Telling patients the truth about their health condition, and explaining any
limitations they might have.
Providing the patient with emotional support.
The goal of cardiac rehabilitation