valvulopathies - carabinsnicois.fr

!"#$%&'()#*+,-./.0-1#2-31/-4#
56786789 - Marie Boileau- #
8#
VALVULOPATHIES,
I. RETRECISSEMENT,AORTIQUE,:,:;/<=/.>;?@-1#/;#A#BC+D=14?1#D=-#E1#?C;F=-?#>;C#/;#
G;/G-B-G;?-.4#F1E#<;/<1E#1?#/1=C#C1,;4-1,14?H#&%)#C+;/-E1#=4#.3E?;G/1#I#/J+K1G?-.4#F=#:2H,
!"#$%&'()*#+),'(-.%#*),/01%#2&/3#
• &%)#,.F+C+#8L9#G,9#L#&%)#,.M14#6LN#78L9#G,9#
• (4F-G;?-.4#G@-C=C0-G;/1#E-#RAO,,serré#OP6LNQ#G,9##.=#P6LQG,97,9R#ST#E1#C1>.C?1C#I#/;#E=CB;G1#
G.C>.C1//1#>.=C#=4#C+E=/?;?E#AC1>C+E14?;?-B#F1#/;#0C;<-?+H,
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Classification,de,la,gravité,des,RAO,grâce,à,:,,
• E=CB;G1##
• 4,05(%*'#5%#6,%77()*#OA#/1#&%)#1E?#0C;<1#A#U!)#
• 8('%77%#/09(/01%#5%7#:;#OA#/1#&%)#1E?#0C;<1#A#/;#:,;V#"R#+<;/=+1#>;C#+G@.#1?#[email protected]#'.>>/1C#
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1. Physiopathologie,
• $.,&<0,4%#7=7')1(-.%#>;C#;=0,14?;?-.4#F1#/;#>.E?SG@;C01##
• Hypertrophie*du*VG*concentrique*(HVG)*sans*dilatation#OE;=B#E?;F1#+<./=+R#
• W.4G?-.4#7=7')1(-.%#F=#:2#/.40?1,>E#&)*7%,8>%##>;CX#
o 2C;F-14?#F1#>C1EE-.4#;.C?.S<14?C-G=/;-C1#G.,>14E+#
o %//.401,14?#F1#/;#F=C+1#FJ+K1G?-.4#
o %=0,14?;?-.4#F1#/;#<-?1EE1#FJ+K1G?-.4##
• W.4G?-.4#5(07')1(-.%#01'>,>%#G;C#/1#,M.G;CF1#>1=#1V?14E-3/1#>;C#Y:'#
• U@+4.,Z41#FJ-EG@+,-1#,M.G;CF-D=1#>;C#G.,>C1EE-.4#F1E#G.C.4;-C1E#>;C#Y:2#
#
2. Etiologie#&;.#F+0+4+C;?-B#[#Maladie*de*Monckeberg#
• :;/<=/.>;?@-1#/;#>/=E#BC+D=14?1L#C1>C+E14?1#9Q\#F1E#<;/<=/.>;?@-1E#
• :-1-//-EE1,14?#F1E#<H#*-0,.]F1E#X#'+>^?E#G;/G;-C1E#C14F;4?#/1E#<;/<1E#-4F=C+1E##
• AAA#G@1_#/1E#>1CE.441E#`0+1E#T#N6#;4E#Oa6\#;>CZE#b6#;4ER#
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3. Diagnostique,
Signes,fonctionnels,à,l’examen,
• Syncope,d’effort,X#?.=K.=CE#?C;=,;?-D=17?,.'01%#1?#70*7#6,)5,)/%#
o /1#F+3-?#EME?+,-D=1#41#>1=?#;=0,14?1C#>.=C#EJ;F;>?1C#;=#31E.-4#14?C;-4;4?#=41#
<;EG=/;C-E;?-.4#G+C+3C;/1#-,>.C?;4?1##
c#>1=?#;=EE-#d?C1#G;=E+#>;C#,;/;F-1#0+4+?-D=1#FJ@M>1C?C.>@-1#F=#E1>?=,#(:#
o ?C.=3/1#F=#CM?@,1##
o 1,3./-1#G;/G;-C1#X#%:$#
#
• Angor,d’effort,:,'.=/1=C#;40-41=E1#C+?C.#E?1C4;/1#-CC;F-;4?#I#2#F=#I#X,
o '+3-?#G.C.4;-C1#-4E=BB-E;4?#I#/J1BB.C?##G;C#X#
# &%)#$#,.-4E#F1#E;40#F;4E#/1#E-4=E#;.C?-D=1#$#,.-4E#F1#C1,>/-EE;01##;C?ZC1E#
G.C.4;-C1E#O%$R#F-;E?./-D=1#
# *?+4.E1#F1E#%$#-4?C;S>;C-+?;/1E#>;C#Y:2#
o %?@+C.EG/+C.E1#;EE.G-+1#OQ6\#F1E#G;ER#
o ",3./-1#G.C.4;-C1#O,.CG1;=V##F1#G;/G;-C1#F1E#<;/<1E#F;4E#%$R#
#
• Dyspnée,d’effort,«,adaptative,»X#($#F-;E?./-D=1#O[($#I#BC;G?-.4#FJ+K1G?-.4#G.4E1C<+1R##>;C#
-4G;>;G-?+#F=#:2#;#E1#C1,>/-C#>=-E#EME?./-D=1#O14#B;G1#?1C,-4;/1#>;C#F-/;?;?-.4R#
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!"#$%&'()#*+,-./.0-1#2-31/-4#
56786789 - Marie Boileau- #
9#
Examen,clinique,,
• U%#F-BB+C14?-1//1#O[#>C1EE-.4#>=/E+1#[#U%F-;E?./1#e#U%EME?./1R#>-4G+1#>;C#;3;-EE1,14?#F1#/;#
EME?./-D=1H##
• $).@@1%#7=7')1(-.%#>A%&'()**%1#B#
o C)1)7=7')1(-.%L#,;V-,=,#,+E.#EME?./-D=1L#F+3=?;4?#;>CZE#f8#1?#E1#?1C,-4;4?#
;<;4?#f9#
o %E>1G?#1)70*4(-.%#X#GC1EG14F.#S#F1GC1EG14F.##
o ;.5%#,D6%.9##
o &)*'%/6),0(*#5.#6).17##
o g;V-,=,#B.M1C#;.C?-D=1##O9"($2R#/1#/.40#;=#3.CF#0;=G@1#F=#E?1C4=,#
o (CC;F-;4?#?(10'>,01%/%*'#F;4E#/1E#:*#F=#G.=#OST#3-/;?+C;/#>.=C#F-BB+C14G-1C#F1#/;#E?+4.E1#
G;C.?-F-1441L#=4-/;?+C;/1HR#
ST#g-1=V#>1Ch=#>14G@+#14#;<;4?#14#B-4#FJ1V>-C;?-.4#
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Signe,clinique,et,paraclinique,d’un,RAO,séré,c31;=G.=>#E.4?#;EM,>?.,;?-D=1E,
• Clinique,,
o *-041#B.4G?-.441/#FJ1BB.C?##
o %=#B.M1C#;.C?-D=1#X#Abolition,de,B2#>;C#C1G.=<C1,14?#F=#E.=BB/1#Y./.EME?./-D=1#D=-#
E1#F+>/;G1#14#?+/+SEME?./-D=1#OC;>>1/#X#f9#[#B1C,1?=C1#F1E#<;/<1E#>=/,.4;-C1E#1?#;.C?-D=1ER#
o g;V-,=,#F=#E.=BB/1#?;CF-B#
o %=#B.M1C#>=/,.4;-C1X#Dédoublement,paradoxal,de,B2#>;C#B1C,1?=C1#F1E#E-0,.]F1E#
>=/,.4;-C1E#;<;4?#/1E#E-0,.]F1E#;.C?-D=1E#O;/.CE#D=1#>@ME-./.0-D=1,14?#GJ1E?#/J-4<1CE1R##
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• Paraclinique,,
o ECG,X#YM>1C?C.>@-1#:2##<-E-3/1#
o Echo,Doppler,X#G;/G=/#F1#/;#E=CB;G1#O!RL#F1#/;#:,;V#F1E#2&#O"R#1?#iU#O!R#
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II. INSUFFISANCE,AORTIQUE,[#C1B/=V#;4.C,;/#F=#E;40#F1#/J;.C?1#<1CE#/1#:2#14#F-;E?./1#,
,
1. Physiopathologie,:,
$Cause,X#'ME?C.>@-1#F1E#<;/<1E#;.C?-D=1E#>;C#B-3C.E1#1?#>C./;>E=E#FJ=41#F1E#5#G=E>-F1E#
$Conséquences,
• En,amont,:,,
o E(10'0'()*#5.#F:#O>C+G@;C01R#AAA#
o C=6%,',)6<(%#G;C#;=0,14?;?-.4#C1/;?-<1#F1#/;#>.E?SG@;C01#OG.4?C;-4?1#>;C-+?;/1R##
o E(/(*.'()*#5%#GH#>;C#;/?+C;?-.4#F1#/;#B.4G?-.4#F=#:2#OB-3C.E1#,M.G;CF-D=1R#W"#F-,-4=1#
G;C#:j*#;=0,14?1H#
• En,aval,X#<=6%,!6.170'(1('>#0,'>,(%11%L##/1#>.=/E#;=0,14?1#G;C##/;#D=;4?-?+#E;40#+K1G?+1#
;=0,14?1#
#
2. Etiologie,$3,types,de,mécanisme,de,l’Insuffisance,aortique##O/1E#,d,1#D=1#(gR#
E1/.4#/;#,.3-/-?+#<;/<=/;-C1#
• (#X#,.3-/-?+#<;/<=/;-C1#4.C,;/1#X#>1CB.C;?-.4#<;/<=/;-C1#
• ((#X#,.3-/-?+#<;/<=/;-C1#;=0,14?+1#X#>C./;>E=E#FJ=41#.=#>/=E-1=CE#G=E>E##
• (((#X#,.3-/-?+#<;/<=/;-C1#C+F=-?1#X#W=E-.4#F1E#G.,,-EE=C1E#A7S##E.=<14?#G;=E+#>;C##C@=,;?-E,1#
;C?+C-1/#;-0=#O&%%R#
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!"#$%&'()#*+,-./.0-1#2-31/-4#
56786789 - Marie Boileau- #
5#
3. Diagnostique,,
• Signes,fonctionnels,X#j;CF-B#1?#3-14#?./+C+L#+<./=?-.4#?CZE#/14?1#
o 'ME>4+1#FJ1BB.C?#>=-E#F1#C1>.E##
o '.=/1=C#;40-41=E1#OF=#B;-?#D=1#/1E#G.C.4;-C1E#E.4?#<;EG=/;C-E+1E#14#F-;E?./1R#
o %E?@+4-1E##
#
• Signes,physiques##[##
o #E.=BB/1#UC.?.S,+E.SF-;E?./-D=1#AA##
o ?C-;40=/;-C1#F1GC1EG14F.##
o ,;V#;=#B.M1C#;.C?-D=1L#3.CF#0;=G@1#F=#E?1C4=,##
o -CC;F-;4?#/1#3.CF#0;=G@1#F=#E?1C4=,#1?#/;#>.-4?1#OE=-?#/1#B/=VR##
o ?-,3C1#5).9#%'#<./>#;E>-C;?-B##
o E.=BB/1#EME?./-D=1##
# B.4G?-.441/#;EE.G-+#X#>;E#F1#C+?C+G-EE1,14?#,;-E#?=C3=/14G1#G;C#A#F1#E;40#I#
+K1G?1CH##
# *-#&%)#;EE.G-+1#
,Diagnostique,d’une,IAO,importante#OI#.>+C1C#kR#
• I10-.%/%*'#/>7)!7=7')1(-.%#O>-E?./SE@.?R#
• ;).1%/%*'#5(07')1(-.%#5%#G1(*'#;=#B.M1C#,-?C;/#X#G.,,1#&g#B.4G?-.441/#OB1C,1?=C1#>;C?-1//1#>;C#/1#
B/=V#FJ(%)R#
• 2;/.>#>C.?.S#F-;E?./-D=1#X#(:2#
• "/;C0-EE1,14?#F1#/;#U%F-BB+C14?-1//1#>;C#;3;-EE1,14?#F1#/;#U%'#1?#,;-4?-14?#F1#/;#U%*#
• YM>1C>=/E;?-/-?+#;C?+C-1//1#X#>.=/E#3.4F-EE;4?##
$#Signe,de,Musset#[##?d?1#D=-#3.=01#?.=?#/J-,>=/E-.4#F1E#G;C.?-F1EL#50*7%#5%7#0,'J,%7K#
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III. INSUFFISANCE,MITRALE,:,91,1#<;/<=/.>;?@-1#/;#A#BC+D=14?1H#(/#B;=?#F-E?-40=1C#X,
,
• IM,aigue,:#>;C#C=>?=C1#F1E#G.CF;01E#.=#F1E#,=EG/1#>;>-//;-C1E#D=-#C1?-14414?#/;#g-?C;/1##
c#C=>?=C1#>.EE-3/1#/.CE#FJ-EG@+,-1#.=#-4B;CG?=E#F=#,M.G;CF1#
• IM,chronique,X#F+0+4+C1EG14G1#>C.0C1EE-<1#F1#/;#,-?C;/1,
• (g#.C0;4-D=1##S#(g#B.4G?-.441//1##
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1. Physiopathologie,:##
• '-/;?;?-.4#F1#)2#
• :2#F-/;?+#,;-E#4.4#@M>1C?C.>@-+#c#G;C#C14<.M1C#F;4E#/J)2#41#F1,;4F1#>;E#>/=E#FJ1BB.C?#;=#:2H#
• W.4G?-.4#EME?./-D=1#G.4E1C<+1#
#
2. Etiologie,$,3,types,de,mécanismes,pour,l’IM,comme,pour,l’IAo##G1??1#G/;EE-B-G;?-.4#
1E?#=4#;-F1#;=#F-;04.E?-D=1#G@-C=C0-G;/H##
cUC-E1#14#G@;C01#F;4E#/1#((#OC=>?=C1#F1E#G.CF;01ER>;C#C1,>/;G1,14?#<;/<=/;-C1#G.,>/1?#
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3. Diagnostique,X#
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• Signes,fonctionnels,:,f-14#?./+C+1,
o %E?@+4-1#B;?-0;3-/-?+#;#/J1BB.C?##
o 'ME>4+1##
o )%U#
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!"#$%&'()#*+,-./.0-1#2-31/-4#
56786789 - Marie Boileau- #
l#
• Signes#physiques,:,##
o U;/>;?-.4#X#[email protected]#F1#>.-4?1#F+<-+#;#0;=G@1#1?#+?;/+#$#&<)&#5%#5L/%#5%#M0,5##
o %=EG=/?;?-.4#X#
# *.=BB/1#<)1)7=7')1(-.%#FJ-4?14E-?+#@(9%#
# "4#K1?#F1#<;>1=C##OF.=V#1?#@=,+R#>;CB.-E#>-;=/;4?##
# g;V#;=#B.M1C#,-?C;/#
# (CC;F-;4?#F;4E#/J;-EE1//1#0;=G@1#
ST#g;/#G.CC+/+#I#/J-,>.C?;4G1#F1#/;#B=-?1H##
Autres,souffles,à,rechercher,
• &.=/1,14?#F-;E?./-D=1#FJ@M>1CF+3-?#
o 2;/.>#0;=G@1#B.4G?-.441/#G;C#A#F1#E;40#F;4E#:2#
o *-041#FJYj%U#X#+G/;?#F1#f9#E.=BB/1#+K1G?-.441/#B.M1C#>=/,.4;-C1##
o %=?C1E#<;/<=/.>;?@-1E##
• %=EG=/?;?-.4#>=/,.4;-C1#X#C`/1E#GC+>-?;4?E#
• *-041E#FJ-4E=BB-E;4G1#G;CF-;D=1#FC.-?1#
#
IV. RETRECISSEMENT,MITRAL,:,*?+4.E1#F1#/;#<;/<1#,-?C;/1#OST#*%#4.C,;/#X#l#I#m#G,9R,
$#&g#E+C+#E-#*g#P8LQ#G,9#
1. Physiopathologie,,
• f;CC;01#,-?C;/L#+/+<;?-.4#F1E#>C1EE-.4E#F;4E#/1E#)2L#F-/;?;?-.4#F1E#)2L#OF.4G#B-3C-//;?-.4#
;=C-G=/;-C1##1?##)%U#AAAR#
• W.4G?-.4#:2#4.C,;/1##
• W%#
• %=0,14?;?-.4#F1#/;#U$)U##
• U=-E#F1#/;#U%U#Yj%U##>.E?#G;>-//;-C1#FJ;3.CF#C+<1CE-3/1##
• U=-E#Yj%U#>C+#1?#>.E?#G;>-//;-C1#,.-4E#C+<1CE-3/1##
• (:'#
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2. Etiologie,:,N)7'#;<./0'(7/%#+,'(&.10(,%#+(4.#O;++P#50*7#QRS#5%7#&07#$W=E-.4E#F1E#
G.,,-EE=C1E#>=-E#C1,;4-1,14?E#F1E#<;/<1E##,-?C;/1E#OG;/G-B-G;?-.4##C+?C;G?-.4#F1E#G.CF;01ER#
ST#&&%#I#/;#E=-?1#FJ=41#,;/;F-1#-4B1G?-1=E1#X#n1E#%G#4J;??;D=14?#>;E#D=1#/1E#3;G?+C-1E#OE?C1>?.G.D=1R#,;-E#;=EE-#/1E#
<;/<1EH##
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3. Diagnostique,,
• Signes,fonctionnels,,
o Y+,.>?-E-1E#X#GC;G@;?#F1#E;40L#;??1-4?1#F=#>.=,.4#E=-?1#;#/JYj%U#>C+G;>-//;-C1H#
o 'ME>4+1##
o U;/>-?;?-.4#
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!"#$%&'()#*+,-./.0-1#2-31/-4#
56786789 - Marie Boileau- #
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• Signes,physiques##
o U;/>-?;?-.4#X#@,>/(77%/%*'#&0'0(,%#O>.EE-3/1#;=EE-#F;4E#&;.#E+<ZC1R#
o %=EG=/?;?-.4#X#rythme*de*DUROZIEZ##
# H&10'#5%#MT#OB1C,1?=C1#F1#,-?C;/1R#;=#B.M1C#,-?C;/#
# $/;D=1,14?#FJ.=<1C?=C1#,-?C;/#>1Ch=#;>CZE#f9##O;??14?-.4#G1#4J1E?#>;E#=4#
F+F.=3/1,14?#F1#f9R#,-E1#14#?14E-.4#F1E#G.CF;01E#C1,;4-+E#/.CE#F1#
/J.=<1C?=C1#F1#/;#<;/<1#,-?C;/1##
# &.=/1,14?#F-;E?./-D=1#F+3=?1#;>CZE#/1#$)g#O[#G/;D=1,14?#FJ.=<1C?=C1#
,-?C;/1R#<;#F1GC1EG14F.#F=C;4?#/;#F-;E?./1#>=-E#E1#C14B.CG1##I#/;#B-4#F1#/;#
F-;E?./1#;=#,.,14?#F1#/;#G.4?C;G?-.4#;=C-G=/;-C1#OB.C,1#F-;3./.R#
# g-1=V#>1Ch=#14#'n2#O[F+G=3-?=E#/;?+C;/#0;=G@1R##
o $=*5,)/%#(*@.*5(?.1)!6.1/)*0(,%#[#+G/;?#F1#f9#;=#B.M1C#>=/,.4;-C1#A#E.=BB/1#
,+E.F-;E?./-D=1#FJ-4E=BB-E;4G1#>=/,.4;-C1#A#C`/1#GC+>-?;4?#;=#3;E1#
2,principales,complications,de,la,RM,:,,
• OAP#U7%.1#%9&%6'()*#5VW+N#70*7#0''%(*'%#5.#F:#XX#
• Fibrillation,auriculaire#>;C#F-/;?;?-.4#F1#/J)2#
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