23. Mitral Valve Regurgitation - etiology, pathophysiology, physical examination, diagnosis and management.

Question 1

what is the cause for mitral valve regurgitation ?

Answer 1

mitral valave prolapse - marfan syndrome due to elongated chords or rupture of chrods

infective endocarditis

fibrosis of papillary muscles, rupture of papillary muscles - acute myocardial infraction
ischemia of papillary muscles

ischemic mitral valve regurgitation - dilation and syfucntion of the mitral annular ring

valvulitis

calcification degenerative

Question 2

what are the symptoms of mitral regurgitate?

Answer 2

dyspnea upon exertion (edema of lungs)

paroxymal nocturnal dyspnea

Question 3

what are found on physical examination

Answer 3

pulating jugular veins

auscultation
weakened S1

systolic murmur immediatley afte s1
heard best at the 5th intercostal space in the midclavicular line or the apex of the heart
ruptured chrodae tendina - murmur may have a seagull quality

S3

ECG - p mitrale in V1 and lead 2

dull precusiion on lung - edema

Question 4

what is the diagnosis of mitral valve insufficiency

Answer 4

echocardiography
regurgitation jets
dilated LA

Question 5

what is a complication that can occur in mitral insufficiency ?

Answer 5

atrial fib- volume tension overload of the LA, and fibrotic processes

Question 6

what is the treatment for for mitral insufficiency ?

Answer 6

if pulmonary congestions - diuretic such as furosemide with k sparing drugs such as spironolactone

surgical therapy is EJ is less than 45 percent
pulmonary hypertension is present
or atrial fib