Nrhiav kab mob plawv: mitral stenosis

Narrowing ntawm cov lus qhib ntawm sab laug lag hauv lub plawv , lub npe hu ua mitral stenosis yeej ib txwm organic. Lub ntsiab yog vim li cas rau txoj kev loj hlob ntawm nrhiav kab mob plawv - rheumatic endocarditis. Ntau tsawg cov ntaub ntawv nrog mitral stenosis endocarditis lwm keeb kwm.

Narrowing atrioventricular orifice npaj raws li ib tug tshwm sim ntawm fusion ntawm lub leaflets ntawm lub mitral valve nrog txhua lwm yam, lawv thickening thiab sealing. Lub valve yuav siv sij hawm rau hauv daim ntawv ntawm ib tug diaphragm nrog ib tug txoj kab txiav positioned nyob rau hauv nruab nrab qhov los yog ib tug funnel zoo.

Lub cheeb tsam ntawm lub mitral orifice nquag 4 - 6 sq. cm. Mitral stenosis ua rau cov kev hloov nyob rau hauv cov ntshav khiav tsis zoo hauv lub plawv. Hemodynamic teeb yuav tshwm sim thaum narrowing qhib rau 1.5 sq. cm. Thaum lub sij hawm diastole, cov ntshav los ntawm sab laug atrium tsis muaj lub sij hawm rau tag nrho mus rau hauv rau sab laug ventricle. Yog li ntawd, nyob rau hauv rau sab laug atrium yog ib tug me me npaum li cas ntawm cov ntshav, uas yog ntxiv cov ntshav los ntawm cov pulmonary leeg. Raws li ib tug tshwm sim, lub atrium yog li puastsuaj tas nrog cov ntshav thiab tsub kom lub siab nyob rau ntawd, uas thawj compensating nce lus thiab atrial stretch. Tab sis raws li cov npag phab ntsa ntawm lub atrium yog tsis muaj zog, nws twb tsis ntev txo contractility, nce congestion thiab lub siab yog ntxiv enhanced. Thaum lub sij hawm muaj stagnation ntawm cov ntshav nyob rau hauv lub ntsig txog kev, ua lub load rau ntawm txoj cai ventricle, muaj congestion nyob rau hauv lub vascular system ntawm lub voj voog loj.

soj ntsuam daim duab

Nrog me ntsis stenosis ntawm kev tsis txaus siab rau tus neeg mob tej zaum yuav tsis muaj lub cev kev ua si yog tsis tshuam txwv. Tus thawj tsis txaus siab, qhia cov tsos ntawm stagnation nyob rau hauv cov hlab ntsha ntawm lub pulmonary kev, yog ua tsis taus pa thiab hnoos - qhuav los yog nrog ib tug me me npaum li cas ntawm cov hnoos, raws li zoo raws li qaug zog thiab palpitations. Nyob rau hauv lub neej yav tom ntej, muaj yog hemoptysis thiab recurrent tawm tsam ntawm mob hawb pob. Mob nyob rau hauv lub plawv zoo nkaus li nyob rau hauv kwv yees li 10% ntawm cov neeg mob.

Mem tes tej zaum yuav tsis yog tib yam rau ntawm ob txhais tes. Qhov no yog vim hais tias cov mob laug atrium squeezes rau sab laug subclavian leeg, thiab sau tus lub siab mus rau sab laug decreases. Feem ntau muaj atrial fibrillation.

Palpation ntawm lub apex ntawm lub plawv yog txiav txim los ntawm lub kos npe rau ntawm lub miv purr. Feline purring tshwm thaum cov ntshav kis los ntawm tus mitral orifice hloov.

Percussion lub plawv ciam teb rau lwm txiav txim offset upwardly thiab mus rau sab xis, uas tshwm sim raws li ib tug tshwm sim ntawm cov kev hloov nyob rau hauv ib tug neeg lag ntawm lub plawv, uas tau txais mitral configuration.

Auscultation ntawm lub plawv yog ib yam uas tseem ceeb heev nyob rau hauv qhov mob ntawm vice li mitral stenosis muaj raug auscultatory suab paj nruag. Saum toj no lub apex ntawm lub plawv auscultated sonorous npuag tes ua ntej laus, diastolic yws yws ua thiab ntxiv tons ua thaum lub sij hawm qhib ntawm lub mitral valve. Tag nrho cov no ntaub ntawv raug auscultatory suab paj nruag, hu ua quails atherosclerosis. Nyob rau hauv lub hauv paus ntawm lub plawv yog auscultated sis thiab phua los yog cleavage II laus, cov tsos ntawm cov uas muaj feem xyuam rau lub stagnation ntawm cov ntshav nyob rau hauv lub ntsws.

Ntshav siab yog feem ntau tsis tau hloov, tej zaum dog dig txo systolic thiab diastolic qab.

diagnostics

Nyob rau radiograph yog txiav txim los ntawm ib tug hloov configuration ntawm lub plawv, hu ua lub mitral thiab congestion.

Lub ECG - tej yam tshwm sim ntawm o ntawm lub plawv lag.

Cov PCG rov hais dua cov kev tshwm sim ntawm auscultation ntawm lub plawv.

Ntawm kuj zoo kawg tseem ceeb nyob rau hauv lub mob uas tsis xws luag echocardiography muab tshem tawm, tas cov valve los mus txiav txim deformation, thickening thiab calcification nws flaps, lub volume kev hloov ntawm lub plawv lag, mob phab ntsa thickness.

kev kho mob

Kev kho mob ntawm stenosis ntawm tej chaw yuav tsum tau phais. Stenoses valve lag luam muaj nyob rau hauv kev ua tau zoo commissurotomy - phais hloov valve leaflets. Lub mitral thiab aortic stenosis, kev kho mob uas yog ua surgically, ua ntej lub lag luam yuav tsum tau hloov dua siab tshiab rau hauv ib tug compensated kauj ruam.