Cardiology #15 (Mitral Valve Disorders) Flashcards

1
Q

What is the pathophysiology of mitral stenosis?

A

Obstruction of flow from LA to LV secondary to narrowed mitral orifice –> blood back up into the LA

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2
Q

What happens when the left atrial pressure becomes too much?

A

There is volume overload –> pulmonary HTN –> CHF

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3
Q

MCC of mitral stenosis

A

Rheumatic heart disease

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4
Q

Other causes of mitral stenosis

A

-Congenital
-Thrombus
-Valvulitis (SLE, amyloid, carcinoid)

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5
Q

Symptoms of mitral stenosis

A

-Dyspnea (MC symptom)
-Hemoptysis, cough
-Pulmonary HTN
-Atrial fibrillation: secondary to atrial enlargement
-Mitral facies: flushed cheeks with facial pallor

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6
Q

In addition, another symptom of Mitral Stenosis is Ortner’s Syndrome. What is this?

A

Recurrent laryngeal nerve palsy due to compression by the dilated left atrium –> hoarseness

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7
Q

Describe the murmur of a patient with mitral stenosis

A

-Prominent S1 (forceful closure of the mitral valve)
-Opening snap (forceful opening of the valve)
-Loud P2
-Low-pitched, diastolic rumbling best heard at the apex

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8
Q

What actions or positions increase the murmur intensity of mitral stenosis and mitral regurgitation?

A

-Left lateral decubitus position
Expiration
Increased venous return (squatting, leg raise, laying supine)

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9
Q

What will be seen on ECG in a patient with mitral stenosis

A

Left atrial enlargement
Atrial fibrillation
Pulmonary HTN (RVH, right axis deviation)

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10
Q

what is the most useful noninvasive diagnostic, and most commonly used diagnostic, for mitral stenosis?

A

Echocardiogram

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11
Q

What’s the most accurate diagnostic for mitral stenosis?

A

Cardiac catheterization

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12
Q

What is the best treatment for symptomatic mitral stenosis in younger patients?

A

Percutaneous balloon valvuloplasty

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13
Q

If percutaneous balloon valvuloplasty is not an option for the patient with mitral stenosis, what is another treatment option that can be pursued?

A

Mitral valve replacement
Diuretics and sodium restriction for edema and volume overload
Anticoagulation for atrial fibrillation, BB, CCB, Digoxin as well

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14
Q

What is the pathophysiology of Mitral Regurgitation

A

Abnormal, retrograde blood flow from the LV to LA, leading to left atrial dilation and increased pulmonary pressure

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15
Q

What is the MC etiology of mitral regurgitation in the US?

A

Mitral valve prolapse

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16
Q

However, the MCC of mitral regurgitation in developing countries is

A

Rheumatic fever

17
Q

Other causes of mitral regurgitation

A

-Endocarditis
-Valvulitis
-Annulus dilation (LV dilation)
-Marfan syndrome

18
Q

Symptoms of mitral regurgitation

A

-Dyspnea (MC)
-Heart failure symptoms (fatigue)
-Atrial fibrillation
-Hemoptysis
-HTN

-Acute: Hypotension, pulmonary edema

19
Q

Describe the murmur of mitral regurgitation

A

-Blowing holosystolic murmur best heard at the apex with radiation to the axilla

20
Q

What actions or positions increase the intensity of mitral regurgitation?

A

Left lateral decubitus position
Expiration
Handgrip
Squatting, leg raise, lying supine

21
Q

What actions DECREASE mitral regurgitation?

A

Valsalva, standing
Amyl nitrate
Inspiration

22
Q

How do you initially diagnose mitral regurgitation?

A

Echo

23
Q

Medical treatment for mitral regurgitation

A

Symptom control with after load reducers (ACEi, ARBs, Nitrates, or diuretics)

24
Q

If surgical intervention is preferred with mitral regurgitation, what options are available?

A

Repair preferred over replacement
–If EF < 60% or refractory to medical therapy

25
Q

What is the pathophysiology of Mitral Valve Prolapse?

A

The leaflets of the mitral valve bulge (prolapse) into the left atrium during systole

26
Q

MVP is the MCC of ______ in the US

A

Mitral regurgitation

27
Q

Mitral valve prolapse is MC in what population?

A

Young women (15-35 years of age)

28
Q

Name some common etiologies of MVP

A

-Myxomatous degeneration of the mitral valve
-Connective tissue diseases: Marfan syndrome, Osteogenesis imperfecta, Ehlers-Danlos syndrome

29
Q

Symptoms of MVP

A

-Most are asymptomatic
-atypical chest pain, panic attacks, palpitations, dizziness, fatigue (autonomic dysfunction)

30
Q

Describe what a patient with MVP may look like on physical examination

A

narrow AP diameter
low body weight
Hypotension
scoliosis
pectus excavatum

31
Q

How do you diagnose MVP

A

Echocardiogram

32
Q

Describe the murmur of MVP

A

-Mid-late systolic ejection click best heard at the apex

33
Q

Which maneuvers make the MVP murmur increase?

A

-Anything that makes the LV smaller (decreases preload): results in an earlier click. Valsalva, standing

34
Q

Which maneuvers make the MVP murmur decrease?

A

Anything that makes the LV bigger (increases preload). Delayed click and shorter murmur duration. Squatting, leg raise, supine. Handgrip.

35
Q

Treatment for MVP

A

Reassurance in most patients (good prognosis)
BB if autonomic dysfunction
Mitral valve repair or replacement if severe or to prevent CHF