1. 1. Valvulopata Mitral Felipe Merlo HEE2 Ctedra Cardiologa
2. 2. Vlvula Mitral Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
3. 3. Vlavulopata Mitral Estenosis Insuficiencia Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
4. 4. Dao Cardiaco de Vlvulas Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
5. 5. Pruebas Diagnsticas Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
6. 6. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
7. 7. ESTENOSIS MITRAL Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
8. 8. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
9. 9. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
10. 10. Caracterizada por el estrechamiento anormal del orificio de la vlvula mitral del corazn. Esta reduccin del orificio valvular es causada por un proceso inflamatorio que puede tambin afectar el aparato sostenedor de la vlvula. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
11. 11. SIGNOS Y SNTOMAS SIGNOS SINTOMAS Pulso irregular Asintomtico Pulso baja intensidad Disnea Facies mitral Tos Signos falla cardiaca Dolor en pecho Soplo difcil de auscultar Palpitaciones Sibilancias Hemoptisis Disfona Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
12. 12. Auscultacin Soplo diasistlico , tono bajo, se ausculta mejor en apex, en decbito lateral izq. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
13. 13. Fisiopatologa
14. 14. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
15. 15. DIAGNOSTICOS INICIALES Clase I: Ecocardiograma torcico Es indicado en pacientes con signos o sntomas de estenosis mitral para establecer el diagnstico, cuantificar severidad hemodinmica (gradiente de presin, rea valvular, y presin arterial pulmonar), valorar lesiones valvulares concomitantes, y demostrar morfologa valvular. (Nivel de evidencia B). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
16. 16. DIAGNOSTICOS INICIALES Clase I: Ecocardiograma transesofgico debera ser considerado en pacientes considerados para comisurotoma percutaena de baln mitral, para valorar la presencia o ausencia de trombo auricular izquierdo.. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
17. 17. DIAGNOSTICOS INICIALES Signos y sntomas cambiantes.- FA, fiebre, hipertiroidismo, estado postoperatorio producen cambios en signos y sntomas. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
18. 18. DIAGNOSTICOS INICIALES Seguimiento rutinario.- 0,09 cm2 decrece el rea de la vlvula por ao, hay que repetir TTE a intervalos determinados en pacientes asintomticos Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
19. 19. DIAGNOSTICOS INICIALES Cateterismo cardiaco.- Es necesario es pacientes sin estudios diagnsticos o cuya clnica y Ecocardiograma sean conflictivos. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
20. 20. DIAGNOSTICOS INICIALES Prueba del Ejercicio.- Clase I: La prueba del ejercicio con Doppler o valoraciones hemodinmica se invasivas es recomendado para evaluar la respuesta del gradiente gradiente mitral y presin arterial pulmonar en pacientes con estenosis mitral cuando hay una discrepancia entre los hallazgos ecocardiogrficos y los signos y sntomas clnicos. (Nivel de evidencia C). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
21. 21. TERAPIA MDICA Clase I: Anticoagulacin ( antagonistas de la vitamina K o heparina) esta indicado en pacientes con 1) estenosis mitral y fibrilacion auricular o 2) estenosis mitral y evento embolsic anterior 3) estenosis mitral y fibrilacion trobtica izquierda. (Nivel de evidencia D). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
22. 22. TERAPIA MDICA Clase IIa: Control de frecuencia cardiaca puede ser beneficioso en pacientes con estenosis mitral y fibrilacin auricular. (Nivel de evidencia C). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
23. 23. TERAPIA MDICA Clase IIb: Control de la frecuencia cardiaca puede ser considerado en pacientes con estenosis mitral con ritmo sinusal normal y sntomas asociados con el ejercicio (nivel de evidencia B). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
24. 24. INSUFICIENCIA MITRAL Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
25. 25. Insuficiencia Mitral Aguda Crnica Primaria Secundaria Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
26. 26. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
27. 27. SIGNOS SNTOMAS Soplo sistlico en base y pex Asintomtico Signos falla cardiaca: Disnea FC alta Debilidad Edema Tos Falla Cardiaca Hemoptisis Dolor de pecho Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
28. 28. Auscultacin Soplo holosistlico, S1 disminuido, desdoblamiendo S2, S3 presente. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
29. 29. INSUFICIENCIA MITRAL AGUDA Desorganizacion partes de la vvula mitral. Por ejemplo una ruptura cordal, ruptura cordal puede ocurrir en pacientes con enfermedad degenerativa mitral. Ruptura del musculo papilar ocurre en pacientes que tienen elevacin del segmento ST asociado a IM. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
30. 30. Diagnostico y Seguimiento TTE Evaluacion de funcin VI, VD, presin arterial pulmonar, y el mecanismo de isuficiencia mitral. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
31. 31. En casos en los que el TTE no nos brinde el diagnostico, pero contine la duda, se puede realizar un TEE. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
32. 32. TERAPIA MDICA Terapia vasodilatadora puede ser til para mejorar la compensacion hemodinmica baja flujo artico. Tambin es comn el uso de nitroprusiato de sodio o nicardipina. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
33. 33. OJO Uso de vasodilatadores pueden producir una exagerada hipotensin por un bajo en las resistencias vasculares perifricas. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
34. 34. TERAPIA MDICA Se recomienda usar el baln contador de pulsaciones aorticas ya que baja la presin sistlica aortica, lo cual reduce el volumen regurgitacin Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
35. 35. TERAPIA MDICA El uso de aparatos percutneos pueden ser efectivos para estabilizar a pacientes con compromiso hemodinmico antes de una operacin. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
36. 36. INTERVECIN La mayora de pacientes necesitaran una intervencin quirrgica, sobre todo si hay ruptura del msculo papilar. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
37. 37. INSUFICIENCIA MITRAL CRNICA
38. 38. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
39. 39. INSUFICIENCIA MITRAL CRNICA Primaria.- Una o ms patologas en los componentes de las vlvulas. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
40. 40. La causa mas comun de insuficiencia primaria mitral es el prolapso valvular. JOVN: Degeneracin mixematosa de la vlvula anterior y posterior ADULTO/ADULTOMAYOR: deficiencia fibroelstica, carencia de tejido conectivo. OTRAS CAUSAS: Enf. Reumtica, hendidura valvular, radiacin, etc. OJO: LA INSUFICIENCIA MITRAL ES LA ENFERMEDAD Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
41. 41. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Practice Guidelines. Circulation. 2014
42. 42. Diagnstico Inicial Clase I: ecocardiografa transtorcica es recomendada para la Evaluacin base de la forma y el tamao del ventrculo izquierdo, funcin del ventrculo derecho y forma de la aurcula izquierda, presin arterial pulmonar, e abismo y severidad de la insuficiencia mitral primaria (estadio A o D), y en cualquier paciente sospechoso de tener insuficiencia mitral crnica primaria. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
43. 43. Diagnstico Inicial Clase I: la cateterizacin de la insuficiencia mitral es indicada en pacientes con insuficiencia mitral crnica primaria para valorar volmenes, funcin y severidad de la insuficiencia mitral del ventrculo derecho e izquierdo cuando los resultados son insatisfactorios con el TTE. (Evidencia B). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
44. 44. Diagnstico Inicial Clase I: Ecocardiograma transesofgico es utilizado para establecer las bases anatmicas para la insuficiencia mitral crnica primaria (estadios C y D), y para tener una gua para la reparacin. (Evidencia B). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
45. 45. Diagnstico Inicial Clase I: Ecocardiograma transesofgico est indicado para la evaluacin de pacientes con insuficiencia mitral crnica primaria (estadios B y D), en quienes los mtodos diagnsticos no invasivos no proveen informacin acerca de la severidad de la insuficiencia mitra, mecanismo de la misma, y/o estatus de la funcin ventricular izquierda. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
46. 46. Diagnstico Inicial Signos y sntomas Cambios .- El aparecimiento de signos y sntomas es una pronostico negativo incluso si la funcin del ventrculo izquierdo sea buena. Repetir la TTE en el momento en que el paciente tiene ,os sntomas esta indicado para confirmar si los sntomas son productores por una insuficiencia mitral del ventrculo izquierdo. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
47. 47. Diagnstico Inicial Seguimiento de rutina.- en pacientes asintomticos una o dos TTE al ao es recomendado. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
48. 48. Diagnstico Inicial Cateterizacin cardiaca .- Se la usa cuando la valoracin clnica es inconclusa o esta en desacuerdo con respecto a: Severidad de Insuficiencia mitral Funcin ventrculo izquierdo Necesidad de ciruga Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
49. 49. Diagnstico Inicial Prueba de Ejercicio Clase IIa: Ejercicio hemodinmica con ecocardiografa Doppler cateterizacin cardiaca es razonable en pacientes sintomticos con insuficiencia primaria crnica donde hay una discrepancia entre sntomas y la severidad de la insuficiencia (estadios B y C). (Nivel de evidencia C). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
50. 50. Diagnstico Inicial Clase IIa: la Ergometra puede ser til en pacientes con insuficiencia primaria crnica mitral para establecer el estado de los sntomas y la tolerancia al ejercicio (estadios B y C). (Nivel de evidencia C). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
51. 51. TERAPIA MDICA Clase IIa: La terapia mdica para disfuncin sistlica es razonable en pacientes con insuficiencia mitral primaria crnica sintomtica (estadio D) ya la fraccin de eyeccin del ventrculo izquierdo sea menor a 60% en quienes la ciruga no es contemplada (nivel de evidencia B). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
52. 52. TERAPIA MDICA Clase III: La terapia vasodilatadora no est indicada para pacientes normotensos asintomticos con insuficiencia mitral crnica primaria (estadios B y C1) y funcin sistlica del ventrculo izquierdo normal. (Nivel de evidencia B). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
53. 53. Intervencin Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
54. 54. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
55. 55. Insuficiencia Mitral Crnica Secundaria Secundaria.- La vlvula es usualmente normal, disfuncin del VI por arteriopata coronaria, IM, o enfermedad idioptica miocrdica. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
56. 56. Insuficiencia Mitral Crnica Secundaria La dilatacin del ventrculo izquierdo produce un desplazamiento de los msculos papilares. OJO La Insuficiencia mitra CS es solo una parte de la enfermedad Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
57. 57. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
58. 58. Diagnostico y Seguimiento Clase I: ecocardiografa transtorcica es til para establecer la etiologa e la insuficiencia mitral secundaria crnica (estadios B y D) y el grado y localizacin del movimiento anormal de la pared, y para valorar la funcin del ventrculo izquierdo, severidad de la insuficiencia mitral y la magnitud de la hipertensin pulmonar. (Nivel de evidencia C). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
59. 59. Diagnostico y Seguimiento Clase I: El mtodo de imagen no invasivo (tomgrafo emisor de positrones), la cateterizacin cardiaca, incluyendo la arteriografia coronaria es til para establecer la etiologa de la insuficiencia mitral crnica secundaria (estadios B o D), y /o valorar la viabilidad miocrdica, que a su vez pueden influenciar en el mantenimiento de la insuficiencia mitral funcional. (Nivel de evidencia C). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
60. 60. TERAPIA MDICA Clase I: pacientes con insuficiencia mitral crnica secundaria (estadios B o D) y falla cardiaca con fraccin de eyeccin del ventrculo izquierdo deber recibir la GDMT(gua terapia mdica) para fallo cardaco, incluyendo IECA, ARAII, beta bloqueadores y/o antagonistas de la aldosterona como indicacin. (Nivel de evidencia ). Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
61. 61. TERAPIA MDICA Clase I: La terapia cardiaca de resincronizacin con estimulacin biventricular esta recomendada es pacientes sintomticos con insuficiencia mitral crnica severa (estadios B o D) Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
62. 62. Intervecin Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, OGara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014
63. 63. GRACIAS