醫學三：80題 ( 包括內科,家庭醫學科等科目及其相關臨床實例與醫學倫理 )題庫下載題庫

(A) http://www.mmh.org.tw/taitam/ped_ca/index4_1_car%20(27).html

過去數十年間，小兒科的領域，後天性心臟疾患以風濕熱為最常見，它會侵犯全身結締組織，尤其對心臟的損害為最，可以造成慢性的風濕性心臟病。近年來，西方國 家的風濕熱發生率已降低，但是在開發中國家發生率仍高，本地亦偶有一些新病例出現。

https://wwwv.tsgh.ndmctsgh.edu.tw/unit/10012/12863

風濕性心臟病:約佔瓣膜性心臟病70%，以女性居多，大多為幼年時患風濕性感染所引起。

(B)

http://web.tfrd.org.tw/genehelp/database/disease/Marfan_news11.html

Marfan's syndrome在超音波影像下常見的情形：
1、二尖瓣脫垂及關閉不全造成反流。
2、左心容量負荷過重，左心室擴大。
3、...

(A) http://www.mmh.org.tw/taitam/ped_ca/index4_1_car%20(27).html

過去數十年間，小兒科的領域，後天性心臟疾患以風濕熱為最常見，它會侵犯全身結締組織，尤其對心臟的損害為最，可以造成慢性的風濕性心臟病。近年來，西方國 家的風濕熱發生率已降低，但是在開發中國家發生率仍高，本地亦偶有一些新病例出現。

https://wwwv.tsgh.ndmctsgh.edu.tw/unit/10012/12863

風濕性心臟病:約佔瓣膜性心臟病70%，以女性居多，大多為幼年時患風濕性感染所引起。

(B)

http://web.tfrd.org.tw/genehelp/database/disease/Marfan_news11.html

Marfan's syndrome在超音波影像下常見的情形：
1、二尖瓣脫垂及關閉不全造成反流。
2、左心容量負荷過重，左心室擴大。
3、主動脈的根部，自主動脈瓣膜後瘤狀樣的擴大，甚至合併主動脈剝離。

https://en.wikipedia.org/wiki/Diastolic_heart_murmur

舒張期雜音代表Aortic regurgitation或Mitral stenosis。並非mitral prolapse。

(C) Uptodate

https://www.uptodate.com/contents/natural-history-and-management-of-chronic-aortic-regurgitation-in-adults?search=aortic%20regurgitation&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H87465658

The following recommendations are consistent with the 2014 American College of Cardiology/American Heart Association guidelines 

For symptomatic patients with severe AR who are candidates for valve surgery, valve replacement is recommended after a period of intense medical treatment including diuretics, angiotensin converting enzyme (ACEi) inhibitor or angiotensin II receptor blocker (ARB), beta blocker, mineralocorticoid receptor antagonist, and digoxin to treat heart failure.

For treatment of hypertension (systolic blood pressure >140 mmHg) in patients with chronic AR, vasodilators such as ACE inhibitors, ARBs, or dihydropyridine calcium channel blockers (eg, amlodipine) are favored since they may reduce systolic blood pressure in this setting. 

Randomized trials studying nifedipine and ACE inhibitors have produced conflicting findings as to whether there is or is not  a clinical benefit from vasodilator therapy.

Aortic valve surgery (predominantly aortic valve replacement) is the mainstay of treatment of symptomatic severe AR and select patients with asymptomatic AR

(D)

左心室末舒張壓（LVEDP > 16 mmHg）代表左心室舒張功能不良。

https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-aortic-stenosis-in-adults?search=aortic%20stenosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3067593883

AS --> LV hypertrophy & fibrosis --> Diastolic dysfunction

 Most patients with AS have left ventricular (LV) hypertrophy with normal systolic function. However, some studies suggest that alterations in ventricular function are present as evidenced by reduced global longitudinal strain. Diastolic dysfunction, secondary to hypertrophy and fibrosis, is common and often persists after valve replacement.