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Estenose e

insuficincia
artica e
mixedema
Bruna Maia
Klber Lins

Gabriel Braga

Hemily Neves

ESTENOSE
ARTICA

Estenose
Artica

Sncope
Dispnia
aos
esforos

Estenose artica um estreitamento da


vlvula artica. A estenose impede a
vlvula de abrir corretamente, forando o
corao a trabalhar mais para bombear o
sangue atravs da vlvula. Em resposta, o
ventrculo
esquerdo
se
torna
hipertrofiado e aumenta de tamanho.
Com o tempo, ele poder perder a sua
fora para bombear o sangue e pode
evoluir para Insuficncia Cardaca.

Angina
Pectoris

Insuficin
cia
Cardaca

Estenose
artica valvar
Abertura total da valva: 2,5 - 3,5 cm
Quando a passagem reduzida:

Aorta
ascendente

Gradiente
de presso
sistlica

Ventrculo
esquerdo

Causas mais comuns de estenose:


Cardiopatia reumtica crnica
Degenerao calcificada
Valva bicspide congnita

Fisiopatologia Adaptao
6

Bomba
auxiliar

4
3

Presso
distolic
a final
5

Enchimento
ventricular

Exame Fsico
1. Pulso Arterial - pulso parvus tardus - Baixa amplitude e Aumenta
lentamente
2. Presso Arterial - convergente
3. Ausculta Cardaca
3.1 Sopros - mesossistlico de ejeo
3.2 Bulhas B2 - Hipofontica
B4 presente - Baixa complacncia ventricular e grande esforo atrial
esquerdo
3.3 Clique de ejeo - Audvel nas fases iniciais

Principais
sintomas

INSUFICIN
CIA
ARTICA

Insuficinci
a
Artica

Dispnia

a incapacidade de fechamento da
vlvula artica, tornando possvel o
refluxo de certa quantidade de sangue
para o ventrculo esquerdo durante a
distole ventricular.
Em resposta ao refluxo sanguneo, ocorre
uma sobrecarga de volume, levando a
uma hipertrofia do ventrculo esquerdo e

Palpita
o
Taquicar
dia

Fraqueza
muscular

Exame Fsico

Sinais
perifricos

Sinais no
nvel do
corao

Exame Fsico
Ictus
cordis

deslocado para baixo


e para a esquerda,
tipo
musculoso
e
amplo

Sinais
do
nvel
do
cora
o
B
1
Normofont
ico

B
2
Hipofonti
co
Ausent
e

Sopro diastlico
aspirativo,
decrescente, audvel
no foco artico ou
artico
acessrio
com irradiao para
a ponta do corao

Exame Fsico

Sinais
perifric
os

6..Sinal de
Minervini
(Pulsao na
base da lngua)
3. Dana das
artrias
(Pulsaes
8. Sinal de
carotdeas)
Rosenbach pulsao do
4. fgado.
Pulso capilar
amplo (Sinal de
Quinke)

1. Sinal de
Musset balano da
cabea
7. Sinal de
Gerhard pulsao do bao
2. Pulso Clere
ou em martelo
dgua
5. Sinal de
Duroziez - (duplo
sopro da artria
femoral)

Manifestaes Clnicas
Palpita
o
Taquicar
dia

Diminuio da
Frao de Ejeo

Dispnia
Ortopni
a
Edema
de

Congesto Pulmonar

Manifestaes Clnicas

Lipotmi
a

Fraqueza

Angina
Noturna

Disfuno do VE

Diminuio da Presso
Diastlica
+

MIXEDEMA

16

Fisiopatologia do
edema
Aumento
da
presso
hidrostti
ca
intracapil
ar
ICC, renal

Presso
onctica
intravascu
lar
reduzida

Aumento
da
presso
onctica
interstici
al

Aumento
da
permeabil
idade
capilar

Drenage
m
linftica
prejudica
da

Hipoalbumine
mia

Mixedema

Alergias,
queimaduras

Filariose

No
muito
intenso

17

Mixedema

Pouco
depressv
el

Forma particular de edema observado na


hipofuno tireoidiana. No se trata de
uma reteno hdrica conforme ocorre nos
outros edemas de uma maneira geral. No
mixedema h deposio de substncia
mucopolissacardica
(glicoprotena)
no
espao
intersticial
e
secundariamente uma certa reteno de
gua.

Alterae
s
cutneas

Inelstic
o

18

Endocrinopatias
Hipotireodismo
franco
Fceis
mixedematosa
um importante
sinal clnico que
aponta para
hipotireoidismo

Hipertireoidismo
Mixedema pr-tibial
Sinal clnico
caracterstico de
hipertireoidismo
autoimune (Doena
de Graves)

19

HIPOTIREOIDISMO
FRANCO (MIXEDEMA) FCEIS
MIXEDEMATOSA

ROSTO
ARREDONDADO

CABELO SECO E
SEM BRILHO

PLPEBRAS
INFILTRADAS E
ENRUGADAS

CLIO ESCASSOS

NARIZ E LBIOS
GROSSOS

SULCOS
ACENTUADOS

PELE SECA E
ESPESSADA

FISIONOMIA
APTICA
Figura: fceis mixedematosa

20

HIPOTIREOIDISMO
FRANCO (MIXEDEMA)

Figura: (A) fceis mixedematosa e (B) fceis normal (Porto,


2014)

21

HIPOTIREOIDISMO
FRANCO (MIXEDEMA)
2. PA discretamente
elevada
5. Derrame pericrdico
7. Hepatomegalia
6. Ascite
8. Dilatao do clon,
fecaloma, leo
paraltico
9. Pseudo-hipertrofia

FCEIS
MIXEDEMATOSA

1. Alteraes na glndula
tireide (bcio)
3. Bulhas hipofonticas e
bradicardia
4. Pulso lento e de pequena
amplitude
10. Pseudomiotonia

22

HIPOTIREOIDISMO
FRANCO (MIXEDEMA)

Figura: Palpao da tireide (Porto,

23

HIPERTIREOIDISMO DOENA DE GRAVES


Oftalmopatia
Acropatia
Mixedema pr-tibial
Placas brilhantes, vermelhoacastanhadas e rugosas
pele de porco

Figura: mixdema pr-tibial (Porto,


2014)

24

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Yellow

Blue

Red

Is the color of gold, butter


and ripe lemons. In the
spectrum of visible light,
yellow is found between
green and orange.

Is the colour of the clear sky


and the deep sea. It is
located between violet and
green on the optical
spectrum.

Is the color of blood, and


because of this it has
historically been associated
with sacrifice, danger and
courage.

Yellow

Blue

Red

Is the color of gold, butter


and ripe lemons. In the
spectrum of visible light,
yellow is found between
green and orange.

Is the colour of the clear sky


and the deep sea. It is
located between violet and
green on the optical
spectrum.

Is the color of blood, and


because of this it has
historically been associated
with sacrifice, danger and
courage.

39
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