Ch 6 MV Regurg Flashcards
What is MR?
Backward flow of blood into LA during systole
What 2 things is MR caused by?
Primary: direct abnormalities of MV apparatus
or
Secondary: due to cardiac disease NOT involving valve
What does the MV apparatus include?
-LA wall
-MV annulus
-Ant + post leaflets
-Chordae
-Pap muscles
-LV myocardium underlying the pap muscles
What causes MV annular dilation?
LA or LV dilation, resulting in MR due to incomplete leaflet coaptation
SF of MV annular calcification?
-Increased echogenicity on the LV side of the annulus, adjacent to the PMVL
-Shadowing due to calcium
How come MV annular calcification leads to MR?
B/c it impairs systolic contraction
List common diseases of the MV leaflets?
-Myxomatous disease (MV prolapse)
-Degenerative disease
-Rheumatic disease
-Endocarditis
-Marfan syndrome
-Infiltrative diseases
-Systemic inflammatory disorders
-Chordal disruption or elongation
-Chordal rupture
SF of MV prolapse?
-Thick leaflets with excessive motion
-Leaflets sag into LA during systole
SF of rheumatic disease?
-Commissural fusion
-Chordal fusion + shortening
SF of endocarditis?
Leaflet destruction, perforation or deformity
SF of marfan syndrome?
Long redundant AMVL that sags into LA during systole
SF of chordal disruption or elongation?
-Severe bowing of MV leaflets, or leaflet segment into the LA
-Leaflets tips still pointed towards apex (this is good)
SF of chordal rupture?
-Flail segment of the leaflet is displaced into the LA during systole
-Leaflet tips now pointing away from the apex (this is bad)
-An eccentric MR jet will occur based on the how the leaflet is affected
(ex. AMVL flail causes an eccentric posterior + lateral jet)
SF of ischemic MR?
-Tenting of MV in systole!!!
-Restricted leaflet motion + tethering of valve closure
-Pap muscle displacement
-An inferolateral basal aneurysm may be seen in pt’s with CAD
SF of a papillary muscle rupture?
Severe MR with CD
(this is a complication of an acute MI)
Is complete or partial pap muscle rupture m/c?
Partial
Treatment of complete pap muscle rupture?
Urgent surgery! Too much MR
3 direction consequences of MR?
-Increase LA volume + pressure
-Reduced CO
-Stress on LV due to volume overload
Differentiate b/w acute + chronic MR?
Acute:
-Normal LA size (non-compliant)
-LAP rises + causes pulmonary edema
Chronic:
-LA enlarged (compliant)
-LAP less elevated + pulmonary congestion is less common
-LV enlargement + hypertrophy results now
Symptoms for acute, chronic + severe MR?
Acute: pulmonary edema + shock
Chronic: low CO, fatigue + weakness
Severe: right heart failure
MR murmurs are described as ___ or ___?
Holosystolic or pansystolic
(mid-late systolic click heard)
___ is the m/c cause of MR in developed countries?
MV prolapse
(aka degenerative/myxomatous MV disease, floppy MV or barlow syndrome)
What is the least + more severe form of MV prolapse?
Least: fibroelastic deficiency
Most: barlow disease
When does MR occur?
Mid-late systole
