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Echo 2 > C9: Mitral Regurg > Flashcards

C9: Mitral Regurg Flashcards

1
Q

define MR

A

backward flow of blood from the LV to the LA during systole

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2
Q

during what time periods does MR occur

A

IVCT, systole and IVRT

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3
Q

general etiology of MR

A

leaflet abnormalities - abnorm. that don’t allow for perfect apposition
chordae tendinae abnormalities
pap abnormalities
ischemia

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4
Q

why is perfect apposition of the valve leaflets so important

A

b/c of the big press difference b/w the LA and LV in systole, if there’s any opening, blood will flow backwards to the LA and take the path w/ least resistance rather than going out the AO

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5
Q

describe the anatomical cause of MV prolapse (MVP)

A

the fibrosa layer of the valve is thinner and the spongiosa is thicker which makes the leaflet too flexible and unable to deal w/ the high PG…. is buckles into the LA

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6
Q

is MVP genetically determined

MVP prevalence

A

yes

2-5%

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7
Q

US appearance of MVP

A

systolic bowing of the belly of the MV leaflet into the LA > 2mm

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8
Q

MVP is associated w/ what other pathologies

A

MR since leaflet tips no longer coapt
chordal rupture
bacterial endocarditis
arrhythmias

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9
Q

which genetic traits/conditions make you more likely to develop MVP

A

tall, slender
pectus excavatum (sternum/ribs indent)
Marfan’s or Ehler Danlos syndrome

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10
Q

when can misalignment of the pap muscles occur

A

when the LV is dilated or hypertrophied

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11
Q

what is the inter-papillary muscle distance (IPMD)

A

distance b/w the PM and AL pap muscles in PSAX mid level

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12
Q

when will the IPMD be increased

A

MR

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13
Q

how can ischemia cause MR

A

if the artery feeding the pap muscle(s) becomes blocked it will not function properly and the LV wall will also be effected

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14
Q

describe the movement of the pap muscle(s) if its supplying artery has become blocked

A

it will move away from the valve plane as the LV dilates (from the ischemia) which tethers the chordae so the leaflet tips can no longer coapt

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15
Q

1 symptom of MR

other symp

A

dyspnea/SOBOE - none w/ mild-mod MR unless theres LV dysfunction or arrhythmias

fatigue
palpations
arrhythmias
CHF

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16
Q

why can SV be increase w/ MR

will this occur w/ arrhythmias?

A

theres extra blood moving through the heart due to the MR which can increase starlings

no, only in norm sinus rhythm

17
Q

murmur heard w/ MR

A

soft blowing at apex

18
Q

how will the heart appear on XRay w/ MR

A

cardiomegaly and pulmonary venous congestion

19
Q

common causes of acute MR

A

large acute MI

trauma

20
Q

how does the LA appear w/ acute MR

A

LA is norm size because it hasn’t had time to dilate to compensate (Important)

21
Q

what will happen to LA press w/ acute MR, what does this cause

A

markedly increased due to inability to dilate….

pulmonary edema and pulmon HTN

22
Q

how is EF effected w/ acute MR

A

usually increased due to increase EDV

23
Q

how does acute MR effect arterial BP

why

A

it drops b/c more blood is going back into the LA than to the AO

24
Q

how does HR change w/ acute MR

A

tachycardia usually

25
Q

does MR cause volume overload, or press overload

A

volume overload

MS causes press overload to the LA

26
Q

how time, what happens to the LA w/ MR…. long term consequences of this?

A

dilates

… PV congestion, afib, CHF

27
Q

With time, what happens to the LV configuration and function w/ MR

A 
eccentric hypertrophy (dilation w/o increased wall thickness)....
.... then an irreversible decrease in systolic fx due to remodeling....
... then LVH and increased dilation w/ CHF

(this is why its important to fix the MV before dilation occurs)

28
Q

describe the changes seen with chronic MR

A

dilation and then hypertrophy

29
Q

2 types of chronic MR

A

chronic compensatory and chronic decompensatory

30
Q

describe chronic compensatory MR

A
  • increased LAP leads to LA dilation to accommodate the extra volume at a lower pressure
  • this increase in volume will increase total forward SV
  • LVEF remains increased for many years (due to starlings) until it starts to fail, and EF decreases
31
Q

describe chronic decompensatory MR

A
  • prolonged increased LV volume damages the muscle fibres n the LV when it fails and Ef starts to drop
  • LVESV increases since less blood is ejected (lower SV)
  • this leads to increased LVEDP and LAP
32
Q

w/ chronic decompensatory MR is EF a good marker of systolic function

why or why not
what do we do instead

A

no, b/c 30-50% of volume is going back into the LA

Dp/Dt instead for systolic function, more accurate

Echo 2 (15 decks)

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