‫القلب فى شريحه‬ Manifestations of Lung congestion 7 items :

PULM .HTN 1- Dyspnea

low cop $ ‫ ويزيد ال‬congestive $ ‫لما يحصل يقل ال‬ 2-orthopnea
3- PND
4- Exertional cough .
5- Recurrent chest infections.
6- Hemoptysis.
7- Pleural effusion.

Manifestations of LA enlargement :
Compression on :
1- trachea  cough & dyspnea.
2- esophagus  dysphagia.
3- LT recurrent laryngeal nerve 
hoarseness of voice.

Manifestations of Systemic congestion : Manifestations of LCOP : 7 items

7 items 1- CNS : dizziness , headache , syncope .
1- Insomnia. 2- CVS : ischemic heart disease .
2- Sweating on slight activity ( LOW COP) ‫برضه‬. 3- Kidney : oliguria .
3- Congested neck vein. 4- Skin : cold , peripheral cyanosis .
4- Edema lower limb , later on ascites. 5- Skeletal muscle : fatigue ,intermittent
5- Liver : enlarged ,soft, tender. claudication.
6- GIT : dyspepsia. 6- Blood pressure : low systolic blood pressure .
7- Pleural effusion. 7- Pulse : weak.
 ‫ كلمات‬4
1- ‫عمود الدم طالع نازل‬

2- Palpitations early  Volume overload

3- LT side HF ( signs)

4- Pan-systolic Murmr
 M.R 5 ‫كلمات‬
( ‫عمود الدم طالع نازل‬, 5 STAGES , Palpitations early ,LT side HF ( signs) ,Pan-systolic Murmr)

C/P
DEF: leakage of blood backward through
the mitral valve each time the left ventricle
contracts.
Symptoms : Signs :
Etiology: 1-Asymptomatic for many years in mild cases.
1- Rheumatic ( the commonest ) 2- Palpitation Early due to LV volume overload. 1- Vitals : ‫ بتوع ال‬LT HF
2-Congenital (HOCM , MVP ) 3- LV failure 1-HR : sinus tachycardia or AF
3-Functional : dilatation of mitral ring due to a) congestive lung $ 7 items 2-PULSE: pulses alternanes and low pulse
dilatation of LV b) LOW COP 7 items volume
- LSHF 4- Pulm HTN (↓ Congestive lung $) 3-BlPr : low systolic BlPr ( LT side HF )
- AR. 5- RT SIDE HF ( Systemic congestion) 4-RR : TACHPNEA ( lung congestion )
4-Ischemic 5- Temp : ↑ if infective endocarditis
5-Infective endocarditis
Local
Hemodynamics: Inspection and palpation : 2- General : ‫ بتوع ال‬LT HF
General appearance : cardiac
Apex: ‫ بتوع ال‬LT HF
cachexia (lt side HF)
-Shifted down and out Decubitus : Orthopnea
ACUTE Chronic -Hyperdnamic Colors :
During systole : -Systolic Thrilll Anemia of chronic disease.
No atrial ↑ ‫عمود الدم طالع‬
Rapid acc of
Pulsations : Cyanosis: peripheral cyanosis.
LA ↑↑
blood  pulm During diastole : -2nd lt intercostal space pulsatins Jaundice: if cardiac cirrhosis.
edema ‫عمود الدم نازل‬ With PULM HTN Neck veins ( Fluid status) :
And cardiogenic Volume overload  congested neck veins
(LUNG CONGESTION
Percussion :
shock AND LV FAILURE ) Dullness in the 2nd left Skin : cold extremities and
intercostals space with pulm HTN peripheral cyanosis
 MR Auscultation Complications Investigations
s1 : ( 3 in valve , 3 in LA , 3 in lung , 2
Muffled failure & complications of surgery ) Echo & Doppler echo : ‫االهم فى الصمامات‬
S2: - Chamber enlargement .
- normal 1. Calcification.
- ↑P2 component in pulm ++ 2. Rheumatic activity. - Detect the severity of the valve lesion.
S3 : With lt side hf volume overload 3. Infective endocarditis.
ECG :
4. Arrhythmia e.g. AF in a case of MS
S4 : with Pulm HTN
5. Thromboembolism : stroke. Chamber enlargement e.g. LA  P mitrale ( m
6. LA enlargement ↑compression on shaped P wave )
Added sound : : Pulmonary hypertension  P pulmonale ( Peaked
1- Lung  dyspnea & cough. P
1- Ejection click : pulm +++ 2- Esophagus dysphagia.
‫فى كل الصمامات الشمال‬ 3- Left recurrent L.N  wave )
2- Gallop on tricuspid area: in RT HF hoarseness of voice.
CXR:
7. Pulmonary congestion :
Murmers : (SCRIPT) 2 murmrs hemoptysis & recurrent chest
Chamber enlargement .
infections. Pulmonary congestion.
1- Pansystolic murmur of MR 8. Pulmonary infection.
Site : best heared on apex but propagated . 9. Pulmonary embolism ( secondary
Character : Soft blowing to DVT ) Treatment
Relation to respiration & position:
↑ with expiration & ↑ in left lateral position 10. RSHF.
Intensity:----------------------------------- 11. LSHF except in MS. ‫مش هتحصل‬
Medical Surgical
Propagation:
Anterior MR : to axilla
12. Complications of surgery
( artificial valves )
1- Prophylaxis against IE valve replacement
& rheumatic activity.
Posterior: base of heart - Mechanical dysfunction. 2- Treatment of or mitral valve
Timing : Mid diastolic - Infective endocarditis.
complications e.g. HF ,
- Thromboembolism.
AF , infections …
repair..
2- Functional MS  mid diastolic rumbling - Hemolytic anemia.
Definition :leakage of blood backward through the mitral valve each time the left
ventricle contracts.

Etiology:
1- Rheumatic ( the commonest )
2-Congenital (HOCM , MVP )
3-Functional : dilatation of mitral ring due to dilatation of LV
- LSHF
- AR.
4-Ischemic
5-Infective endocarditis
Hemodynamics:
ACUTE
1- Backward failure : With severe
MI the compliance of the left atrium
doesn't allow much dilatation 
the left atrial pressure rises
Pulmonary edema
2- Because the pressure in LT atrium is
lower than Aortic pressure  huge amount
the blood to regurge to the atrium which
causes Low COP  Cardiogenic shock (
emergenc surgical repair )
Na+ nitroprusside ‫وقلل الضغط فى االورطى بال‬
Chronic
‫ تدريجيا‬atrium ‫ يوسع ال‬atrium ‫ عمود الدم طالع فى ال‬-1
‫ ويوسع ال‬volume overload ‫ يعمل‬ventricle ‫ عمود الدم نازل على ال‬-2
‫ تدريجيا برضه‬ventricle
1 - During systole : A part of blood regurgitates from LV to
LA leading to LA dilatation .
2- During diastole :  blood flow through the mitral valve
  volume load on LV  LV
enlargement then failure.
Clinical picture :

SYMPTOMS : 5 STAGES 4 ‫ كانوا‬MS ‫ال‬

1- LT atrial dilatation  Asmptomatic

2- Lt ventricular dilatation ( Volume overload )  palpitation ( Hyperdnamic apex) ‫يسمع صوتها وهو نايم‬

Congestive lung smptoms

3- LV failure
Low cop smptoms

↓Congestive lung symptoms & ↑ Low cop smptoms

4-Pulm. HTN

5- RT side HF lately
Signs : auscultation ‫ ونلزقهم هنا ماعدا ال‬LV failure ‫ننسخ ال‬

1- Vitals : ‫ بتوع ال‬LT HF 3- Local

Inspection and palpation :
1-HR : sinus tachycardia or AF
2-PULSE: pulses alternanes and low pulse volume
Apex: ‫ بتوع ال‬LT HF
3-BlPr : low systolic BlPr ( LT side HF ) -Shifted down and out
4-RR : TACHPNEA ( lung congestion )
5- Temp : ↑ if infective endocarditis -Hyperdynamic
-Systolic Thrill
2- General : ‫ بتوع ال‬LT HF
Pulsations :
General appearance : cardiac cachexia (lt side HF) -2nd lt intercostal space pulsatins
Decubitus : Orthopnea With PULM HTN
Colors : Percussion :
Anemia of chronic disease.
Cyanosis: peripheral cyanosis.
Dullness in the 2nd left
Jaundice: if cardiac cirrhosis. intercostals space with pulm HTN
Neck veins ( Fluid status) : congested neck veins
Skin : cold extremities and peripheral cyanosis
 MR Auscultation
Murmers : (SCRIPT) 2 murmrs
s1 : Muffled

S2: 1- Pansystolic murmur of MR

- normal
- ↑P2 component in pulm ++
Site : best heared on apex but propagated .
S3 : With lt side hf volume overload WITH CONE
Character : Soft blowing
‫مرتضى‬ S
Relation to respiration & position: S
S4 : with Pulm HTN ‫بحبك‬ ↑ with expiration & ↑ in left lateral position 1 Pan systolic 2
Intensity:-----------------------------------
Propagation:
Anterior MR : to axilla
Added sound : Posterior: base of heart
Timing : Mid diastolic
1- Ejection click : pulm +++
‫فى كل الصمامات الشمال‬ 2- Functional MS  mid diastolic rumbling
2- Gallop on tricuspid area: in RT HF
Investigations :
Echo & Doppler echo : ‫االهم فى الصمامات‬
- Chamber enlargement .
- Detect the severity of the valve lesion.

ECG : ‫ زى ال‬MS
Chamber enlargement e.g.
LA  P mitrale ( m shaped P wave )
LVH
Pulmonary hypertension  P pulmonale ( Peaked P
wave )

CXR:
Chamber enlargement .
Pulmonary congestion.
 3 in valve
1. Calcification.
2. Rheumatic activity.
3. Infective endocarditis.

3 in LA
4. Arrhythmia e.g. AF in a case of MS
5. Thromboembolism : stroke.
6. LA enlargement ↑compression on :
2 failure
1- Lung  dyspnea & cough.
2- Esophagus dysphagia. 10. RSHF.
3- Left recurrent L.N  11. LSHF except in MS. ‫مش هتحصل‬
hoarseness of voice.

3 in lung complications of surgery

7. Pulmonary congestion :
hemoptysis & recurrent chest infections.
8. Pulmonary infection.
9. Pulmonary embolism ( secondary to
DVT )
12. Complications of surgery
( artificial valves )
- Mechanical dysfunction.
- Infective endocarditis.
- Thromboembolism.
- Hemolytic anemia.
 Treatment

Medical Surgical
1- Prophylaxis against IE
& rheumatic activity. valve replacement or mitral
valve repair.
2- Treatment of
complications e.g.
1-HF ( Diuretics )
2- AF (Rate , rhytm , thromboembolism )
3- infections …
 Mitral valve prolapse
DEF: Prolapse of one or both cusps of mitral valve into LA
during systole.

Etiology : Unknown but more common in young female

c/p : Asymptomatic in most cases

Atypical chest pain

Palpitation.

Investigations : Echo is diagnostic

Treatment :
o Reassurance. o  blocker
o valve replacement in severe cases.