Atlanta Heart Doctor explains the Mitral Valve - YouTube
Atlanta Heart Doctor shows mitral valve prolapse and regurgitation. View more animations at and more videos at
Atlanta Heart Doctor shows mitral valve prolapse and regurgitation. View more animations at and more videos at
http://www.kmuh.org.tw/www/kmcj/data/9608/13.htm
二尖瓣脫垂--最常見的瓣膜心臟病
心臟內科
李香君 主治醫師(96年8月)
二尖瓣脫垂的盛行率約為2.4%,是最常見的瓣膜心臟病。它是一種症候群,可以是二尖瓣的葉片、腱索、乳突肌、或是瓣膜環的任一或多種結構異常所造成,可能伴隨二尖瓣閉鎖不全(逆流)。
造成二尖瓣脫垂的原因是什麼?
部分二尖瓣脫垂有遺傳傾向,發生率女性是男性的兩倍。一等血親有二尖瓣脫垂、身材較清瘦的人、先天性直背、扁胸、或凹胸的,比較常發現二尖瓣脫垂。由於二尖瓣的結禘組織產生變化,二尖瓣的海綿樣結構的中間層異常增生,造成二尖瓣外觀上變厚、變長,在閉合時出現了脫垂現象因而稱為二尖瓣脫垂。
二尖瓣脫垂要如何確定診斷?
臨床上常表現包括心悸、胸口不適、容易疲倦等非特異症狀,也常呈現易焦慮緊張的傾向。醫師的聽診器是第一道診斷利器,可以聽到典型的心縮中期敲擊音與可能伴隨的收縮期心雜音,而確定診斷的工具是心臟超音波。單純二尖瓣脫垂必須有高於二尖瓣膜環連線2毫米以上的程度才符合國際診斷標準。還有其他如瓣膜增厚等等變化可以用來確認二尖瓣脫垂的診斷。應避免過度診斷以免造成不必要的個人心理負擔與醫療支出的浪費。
二尖瓣脫垂需要開刀嗎?
有些二尖瓣結禘組織變化會延伸到瓣膜的腱索、瓣膜環而造成腱索斷裂、瓣膜環擴大鈣化,從而併發中度到重度的二尖瓣閉鎖不全。所幸這些只佔所有二尖瓣脫垂中的10
%左右。重度二尖瓣脫垂與逆流的處理原則與開刀的適應症和其他原因造成的重度逆流並無不同。其他二尖瓣脫垂的可能併發症?
有少部分因為瓣膜表面內皮層損傷引發血栓性病變如腦中風、视網膜動脈阻塞等;少部分會合併心律不整。二尖瓣脫垂合併逆流與心雜音者罹患感染性心內膜炎機率較常人為高。而突發性心臟猝死則和重度二尖瓣逆流、嚴重瓣膜結構異常、或合併心室性心律不整有關。
二尖瓣脫垂的藥物治療
beta阻斷劑或併用抗焦慮劑藥物,可以改善大多數的症狀,但瓣膜的結構不會因藥物而有所改變。如果病人合併心律不整或瓣膜逆流引起的心臟擴大,則可能需要其他抗心律不整藥物或心臟病用藥。
二尖瓣脫垂多久要追蹤一次?
如果二尖瓣的功能正常且無特定症狀的人,因預後良好,應該鼓勵維持正常生活型態,約3至5年追蹤一次心臟超音波檢查。如果合併明顯收縮期雜音與二尖瓣逆流,那麼預防心內膜炎的抗生素就有其必要性;這群病人必須更頻繁地接受醫師追蹤,大約每年追蹤一次心臟超音波。
綜合以上討論,對二尖瓣脫垂有了更深一層的認識。別忘了,大多數的二尖瓣脫垂都是良性表現,通常預後良好,只需要觀察與數年一次心臟超音波追蹤即可。如有任何疑問,可到本院心臟內科門診與醫師討論,不要讓二尖瓣脫垂成為您的心理負擔,您仍然可以和常人一樣享受健康活躍的生活。
Heart Anatomy
http://www.cardioconsult.com/Anatomy/
Heart Anatomy
Simply click on a region of the heart on the diagrams or the
hyperlinks listed below to learn more about the structures of the
heart.
1 Right Coronary
2 Left Anterior Descending
3 Left Circumflex
4 Superior Vena Cava
5 Inferior Vena Cava
6 Aorta
7 Pulmonary Artery
8 Pulmonary Vein
9 Right Atrium
10 Right Ventricle
11 Left Atrium
12 Left Ventricle
13 Papillary Muscles
14 Chordae Tendineae
15 Tricuspid Valve
16 Mitral Valve
17 Pulmonary Valve
Aortic Valve (Not pictured)
Coronary Arteries
Because the heart is composed primarily of cardiac muscle tissue
that continuously contracts and relaxes, it must have a constant
supply of oxygen and nutrients. The coronary arteries are the
network of blood vessels that carry oxygen- and nutrient-rich
blood to the cardiac muscle tissue.
The blood leaving the left ventricle exits through the aorta, the
body’s main artery. Two coronary arteries, referred to as the
"left" and "right" coronary arteries, emerge from the beginning of
the aorta, near the top of the heart.
The initial segment of the left coronary artery is called the left
main coronary. This blood vessel is approximately the width of a
soda straw and is less than an inch long. It branches into two
slightly smaller arteries: the left anterior descending coronary
artery and the left circumflex coronary artery. The left anterior
descending coronary artery is embedded in the surface of the front
side of the heart. The left circumflex coronary artery circles
around the left side of the heart and is embedded in the surface
of the back of the heart.
Just like branches on a tree, the coronary arteries branch into
progressively smaller vessels. The larger vessels travel along the
surface of the heart; however, the smaller branches penetrate the
heart muscle. The smallest branches, called capillaries, are so
narrow that the red blood cells must travel in single file. In the
capillaries, the red blood cells provide oxygen and nutrients to
the cardiac muscle tissue and bond with carbon dioxide and other
metabolic waste products, taking them away from the heart for
disposal through the lungs, kidneys and liver.
When cholesterol plaque accumulates to the point of blocking the
flow of blood through a coronary artery, the cardiac muscle tissue
fed by the coronary artery beyond the point of the blockage is
deprived of oxygen and nutrients. This area of cardiac muscle
tissue ceases to function properly. The condition when a coronary
artery becomes blocked causing damage to the cardiac muscle tissue
it serves is called a myocardial infarction or heart attack.
Superior Vena Cava
The superior vena cava is one of the two main veins bringing
de-oxygenated blood from the body to the heart. Veins from the
head and upper body feed into the superior vena cava, which
empties into the right atrium of the heart.
Inferior Vena Cava
The inferior vena cava is one of the two main veins bringing
de-oxygenated blood from the body to the heart. Veins from the
legs and lower torso feed into the inferior vena cava, which
empties into the right atrium of the heart.
Aorta
The aorta is the largest single blood vessel in the body. It is
approximately the diameter of your thumb. This vessel carries
oxygen-rich blood from the left ventricle to the various parts of
the body.
Pulmonary Artery
The pulmonary artery is the vessel transporting de-oxygenated
blood from the right ventricle to the lungs. A common
misconception is that all arteries carry oxygen-rich blood. It is
more appropriate to classify arteries as vessels carrying blood
away from the heart.
Pulmonary Vein
The pulmonary vein is the vessel transporting oxygen-rich blood
from the lungs to the left atrium. A common misconception is that
all veins carry de-oxygenated blood. It is more appropriate to
classify veins as vessels carrying blood to the heart.
Right Atrium
The right atrium receives de-oxygenated blood from the body
through the superior vena cava (head and upper body) and inferior
vena cava (legs and lower torso). The sinoatrial node sends an
impulse that causes the cardiac muscle tissue of the atrium to
contract in a coordinated, wave-like manner. The tricuspid valve,
which separates the right atrium from the right ventricle, opens
to allow the de-oxygenated blood collected in the right atrium to
flow into the right ventricle.
Right Ventricle
The right ventricle receives de-oxygenated blood as the right
atrium contracts. The pulmonary valve leading into the pulmonary
artery is closed, allowing the ventricle to fill with blood. Once
the ventricles are full, they contract. As the right ventricle
contracts, the tricuspid valve closes and the pulmonary valve
opens. The closure of the tricuspid valve prevents blood from
backing into the right atrium and the opening of the pulmonary
valve allows the blood to flow into the pulmonary artery toward
the lungs.
Left Atrium
The left atrium receives oxygenated blood from the lungs through
the pulmonary vein. As the contraction triggered by the sinoatrial
node progresses through the atria, the blood passes through the
mitral valve into the left ventricle.
Left Ventricle
The left ventricle receives oxygenated blood as the left atrium
contracts. The blood passes through the mitral valve into the left
ventricle. The aortic valve leading into the aorta is closed,
allowing the ventricle to fill with blood. Once the ventricles are
full, they contract. As the left ventricle contracts, the mitral
valve closes and the aortic valve opens. The closure of the mitral
valve prevents blood from backing into the left atrium and the
opening of the aortic valve allows the blood to flow into the
aorta and flow throughout the body.
Papillary Muscles
The papillary muscles attach to the lower portion of the interior
wall of the ventricles. They connect to the chordae tendineae,
which attach to the tricuspid valve in the right ventricle and the
mitral valve in the left ventricle. The contraction of the
papillary muscles opens these valves. When the papillary muscles
relax, the valves close.
Chordae Tendineae
The chordae tendineae are tendons linking the papillary muscles to
the tricuspid valve in the right ventricle and the mitral valve in
the left ventricle. As the papillary muscles contract and relax,
the chordae tendineae transmit the resulting increase and decrease
in tension to the respective valves, causing them to open and
close. The chordae tendineae are string-like in appearance and are
sometimes referred to as "heart strings."
Tricuspid Valve
The tricuspid valve separates the right atrium from the right
ventricle. It opens to allow the de-oxygenated blood collected in
the right atrium to flow into the right ventricle. It closes as
the right ventricle contracts, preventing blood from returning to
the right atrium; thereby, forcing it to exit through the
pulmonary valve into the pulmonary artery.
Mitral Value
The mitral valve separates the left atrium from the left
ventricle. It opens to allow the oxygenated blood collected in the
left atrium to flow into the left ventricle. It closes as the left
ventricle contracts, preventing blood from returning to the left
atrium; thereby, forcing it to exit through the aortic valve into
the aorta.
Pulmonary Valve
The pulmonary valve separates the right ventricle from the
pulmonary artery. As the ventricles contract, it opens to allow
the de-oxygenated blood collected in the right ventricle to flow
to the lungs. It closes as the ventricles relax, preventing blood
from returning to the heart.
Aortic Valve
The aortic valve separates the left ventricle from the aorta. As
the ventricles contract, it opens to allow the oxygenated blood
collected in the left ventricle to flow throughout the body. It
closes as the ventricles relax, preventing blood from returning to
the heart.
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※ 編輯: ott 時間: 2016-03-05 14:12:52
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