老年人心瓣膜病合并房颤及心衰的处理原则.ppt

老年人心瓣膜病合并房颤及心衰的处理原则;随着人口的老龄化,老年退行性钙化性瓣膜病逐渐占有重要的地位,是目前老年人的特殊疾病。 已经成为老年人心力衰竭、心律失常、晕厥、猝死的原因之一。 对冠心病具有重要预测价值;;;国外报道的发病率明显高于国内。Pomerance 等 尸检162 例死于心衰的患者, 分析其原因后发现钙化性瓣膜病变占45 % ,仅次于冠心病。 Wong 等 在78 例65～102 岁的患者中 发现瓣膜退行性改变占74 %。 90～100 岁年龄组几近100 % Springer. Verlag ,1982 :63～67. . J AM Geriatir soc ,1983 ,3l :156.;;;Mitral stenosis was found in 23 cases (6.4%), of which 21 cases were rheumatic and the remaining 2 were mitral ring calcification (MRC). Mitral regurgitation was observed in 126 cases (35.3%): 69 of papillary muscle dysfunction, 26 of mitral valve prolapse (MVP), 16 of MRC, 9 of ruptured chordae tendineae, 3 of rheumatic and 3 of congenital. Jpn Circ J. 1982 Apr;46(4):337-45 ;Aortic stenosis was noted in 33 cases (9.2%): 27 of calcified, 5 of rheumatic and one of congenital. Aortic regurgitation was found in 169 cases (47.2%): 112 of degenerative, 47 of syphilitic, 7 of rheumatic and 2 of aortitis syndrome. There were 6 cases (1.7%) of tricuspid regurgitation. Jpn Circ J. 1982 Apr;46(4):337-45 ;Etiological classification revealed 6 cases (1.7%) of congenital, 36 (10%) of rheumatic, 49 (13.7%) of syphilitic, 27 (7.5%) of MVP, 69 (19.3%) of ischemic and 166 (46.4%) of degenerative valvular disease. Jpn Circ J. 1982 Apr;46(4):337-45 ;A total of 458 cases (11.5%) with valvular heart diseases in the aged (greater than or equal to 60 years) were found among 4,000 consecutive autopsies. They included 204 cases (45%) of aortic regurgitation (AR), 171 cases (37%) of mitral regurgitation (MR), followed by 45 (10%) of aortic stenosis (AS) and 27 cases (6%) of mitral stenosis (MS). J Cardiol Suppl. 1988;19:29-38. ;;;;仍关注对老年人风心病;;;;A Novel Role of the Sympatho-Adrenergic System in Regulating Valve Calcification;;老年瓣膜病合并房颤;老年瓣膜病合并房颤;;;;首先老年瓣膜病合并冠心病、高血压者居多, 其次为糖尿病, 表明动脉粥样硬化的易患因素如高血压、高胆固醇、高血糖也是导致瓣膜钙化的重要因素。因此老年人应尽早防治各种引起动脉硬化的因素, 这样可能延缓退行性心瓣膜病的发生, 从而减少各类心律失常的发生, 降低死亡率;其次此症除与心房肌缺血有关外, 一个主要 因素是心房肌的退行性变, 这与瓣膜的退行 性病变是一致 的。一些心房纤颤, 部分快速 性心房纤颤经治疗转复窦律后伴有T 波倒置 外,