Cardiology #15 (Mitral Valve Disorders) Flashcards
What is the pathophysiology of mitral stenosis?
Obstruction of flow from LA to LV secondary to narrowed mitral orifice –> blood back up into the LA
What happens when the left atrial pressure becomes too much?
There is volume overload –> pulmonary HTN –> CHF
MCC of mitral stenosis
Rheumatic heart disease
Other causes of mitral stenosis
-Congenital
-Thrombus
-Valvulitis (SLE, amyloid, carcinoid)
Symptoms of mitral stenosis
-Dyspnea (MC symptom)
-Hemoptysis, cough
-Pulmonary HTN
-Atrial fibrillation: secondary to atrial enlargement
-Mitral facies: flushed cheeks with facial pallor
In addition, another symptom of Mitral Stenosis is Ortner’s Syndrome. What is this?
Recurrent laryngeal nerve palsy due to compression by the dilated left atrium –> hoarseness
Describe the murmur of a patient with mitral stenosis
-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
What actions or positions increase the murmur intensity of mitral stenosis and mitral regurgitation?
-Left lateral decubitus position
Expiration
Increased venous return (squatting, leg raise, laying supine)
What will be seen on ECG in a patient with mitral stenosis
Left atrial enlargement
Atrial fibrillation
Pulmonary HTN (RVH, right axis deviation)
what is the most useful noninvasive diagnostic, and most commonly used diagnostic, for mitral stenosis?
Echocardiogram
What’s the most accurate diagnostic for mitral stenosis?
Cardiac catheterization
What is the best treatment for symptomatic mitral stenosis in younger patients?
Percutaneous balloon valvuloplasty
If percutaneous balloon valvuloplasty is not an option for the patient with mitral stenosis, what is another treatment option that can be pursued?
Mitral valve replacement
Diuretics and sodium restriction for edema and volume overload
Anticoagulation for atrial fibrillation, BB, CCB, Digoxin as well
What is the pathophysiology of Mitral Regurgitation
Abnormal, retrograde blood flow from the LV to LA, leading to left atrial dilation and increased pulmonary pressure
What is the MC etiology of mitral regurgitation in the US?
Mitral valve prolapse
However, the MCC of mitral regurgitation in developing countries is
Rheumatic fever
Other causes of mitral regurgitation
-Endocarditis
-Valvulitis
-Annulus dilation (LV dilation)
-Marfan syndrome
Symptoms of mitral regurgitation
-Dyspnea (MC)
-Heart failure symptoms (fatigue)
-Atrial fibrillation
-Hemoptysis
-HTN
-Acute: Hypotension, pulmonary edema
Describe the murmur of mitral regurgitation
-Blowing holosystolic murmur best heard at the apex with radiation to the axilla
What actions or positions increase the intensity of mitral regurgitation?
Left lateral decubitus position
Expiration
Handgrip
Squatting, leg raise, lying supine
What actions DECREASE mitral regurgitation?
Valsalva, standing
Amyl nitrate
Inspiration
How do you initially diagnose mitral regurgitation?
Echo
Medical treatment for mitral regurgitation
Symptom control with after load reducers (ACEi, ARBs, Nitrates, or diuretics)
If surgical intervention is preferred with mitral regurgitation, what options are available?
Repair preferred over replacement
–If EF < 60% or refractory to medical therapy
What is the pathophysiology of Mitral Valve Prolapse?
The leaflets of the mitral valve bulge (prolapse) into the left atrium during systole
MVP is the MCC of ______ in the US
Mitral regurgitation
Mitral valve prolapse is MC in what population?
Young women (15-35 years of age)
Name some common etiologies of MVP
-Myxomatous degeneration of the mitral valve
-Connective tissue diseases: Marfan syndrome, Osteogenesis imperfecta, Ehlers-Danlos syndrome
Symptoms of MVP
-Most are asymptomatic
-atypical chest pain, panic attacks, palpitations, dizziness, fatigue (autonomic dysfunction)
Describe what a patient with MVP may look like on physical examination
narrow AP diameter
low body weight
Hypotension
scoliosis
pectus excavatum
How do you diagnose MVP
Echocardiogram
Describe the murmur of MVP
-Mid-late systolic ejection click best heard at the apex
Which maneuvers make the MVP murmur increase?
-Anything that makes the LV smaller (decreases preload): results in an earlier click. Valsalva, standing
Which maneuvers make the MVP murmur decrease?
Anything that makes the LV bigger (increases preload). Delayed click and shorter murmur duration. Squatting, leg raise, supine. Handgrip.
Treatment for MVP
Reassurance in most patients (good prognosis)
BB if autonomic dysfunction
Mitral valve repair or replacement if severe or to prevent CHF
