6.5 MTB Step 3 - Valvular Heart Disease (Mitral Regurgitation) Flashcards
MITRAL REGURGITATION
What are (3) Causes of Mitral Regurgitation?
- Hypertension (HTN)
- Ischemic Heart Disease
- Any other condition that leads to Dilation of the Heart
MITRAL REGURGITATION
What is the Most Common Symptom of Mitral Regurgitation?
Dyspnea on Exertion
MITRAL REGURGITATION
Which (3) Physical Conditions is an S3 Gallop on Cardiovascular Exam associated with?
- Congestive Heart Failure (CHF = fluid overload state)
- Mitral Regurgitation (MR = fluid overload state)
- Normal in patients Age < 30 yo.
MITRAL REGURGITATION
Describe the Murmur of Mitral Regurgitation (MR).
- Holosystolic and Obscures both S1 & S2.
- Heart best at the Apex and Radiates to the Axilla.
- Increases in Intensity with Leg Raise, Squatting, and Handgrip.
- Decreases in Intensity with Standing, Valsalva, and Amyl Nitrate.
- S3 Gallop is often present.
MITRAL REGURGITATION
- What is the Best INITIAL Diagnostic Test for Mitral Regurgitation (MR)?
- What is a MORE Accurate Diagnostic Test for Mitral Regurgitation (MR)?
- TTE
- TEE
MITRAL REGURGITATION
What are the (3) Best INITIAL Therapies and the medications Most Likely to decrease the rate of progression of Mitral Regurgitation (MR)?
- ACEIs
- ARBs
- Nifedipine
- For CCS, Add a Loop Diuretic (e.g., Furosemide).
- Vasodilators / Afterload Reducers that slow progression.
- If patient still progresses despite medical therapy, then surgical replacement of the valve should be performed.
MITRAL REGURGITATION
When is Surgery the right treatment for Mitral Regurgitation, even if the patient is Asymptomatic?
Left Ventricular EF < 60%
or
Left Ventricular End Systolic Diameter > 40mm
MITRAL REGURGITATION
What are the (2) Surgical Procedures for Mitral Regurgitation (MR)?
- Valve REPAIR - placing clips or sutures on the valve to tighten it up.
- Valve REPLACEMENT
