심장판막질환

Mitral Insufficiency

I. 원인
1. rheumatic fever; 50 %
2. dilatation of mitral valve annulus (5 - 6 cm)
3. prolapse of mitral valve (floppy valve)
4. bacterial endocarditis
5. rupture of chordae tendinae
6. papillary muscle dysfunction or rupture (coronary artery dis.)
7. degenerative change
8. ischemic heart disease : posteroinferior MI시 papillary muscle의 dysfunction

II. 병태생리
regurgitation (reflux of part of the stroke volume of the contracting left ventricle into
LA)
1. LV 의 volume overload → LV failure, EF감소
2. LA의 compliance가 MR의 임상적, 역학적 소견 결정에 중요
① normal or reduced compliance
a) acute MR에서 pul. edema가 흔함
b) LA. pressure가 상승 → tall T wave
② increased compliance
a) chronic MR에서 AF가 흔함
b) LA enlargement, LA pr.는 정상 or 약간 상승

III. 임상소견 및 진단
1. Symptom & Sign
① weakness, fatigability, palpitation, dyspnea on exertion
MS vs MR
hemoptysis, systemic embolism : MS > MR
fatigue, exhaustion, …