Chronic Mitral Valve Insufficiency

Question 1

Etiology of MR:

Rheumatic heart disease is an example of a problem with ____ of the mitral valve

Answer 1

leaflet shortening

Question 2

Etiology of MR:

Myxomatous valve and prolapse are examples of a problem with ____ of the mitral valve

Answer 2

redundant leaflets

Question 3

Etiology of MR:

Marfan’s syndrome is an example of a problem with ____ of the mitral valve

Answer 3

M.V. annulus calcification

Question 4

Etiology of MR:
LV dilatation (like in CHF) due to systolic dysfunction is an example of a problem with \_\_\_\_ of the mitral valve

Answer 4

papillary muscle malalignment

Question 5

Etiology of MR:

MR secondary to atherosclerotic coronary artery disease is an example of a problem with ____ of the mitral valve

Answer 5

Papillary muscle dysfunction/rupture

Question 6

Etiology of MR:

Endocarditis is an example of a problem with ____ of the mitral valve

Answer 6

Chordae tendineae rupture

Question 7

Mitral valve prolapse is histologically caused by ____

Answer 7

myxomatous (connective tissue) degeneration of varying amounts of leaflets

Question 8

What would you hear upon auscultation of Mitral Valve Prolapse?

Answer 8

Click-murmur

Question 9

Auscultation of Mitral Valve Prolapse:
Sitting/standing moves systolic click (closer to/further from) to S1 and the murmur is (shortened/prolonged) due to (increase/recrease) in ventricular volume.

Answer 9

closer
prolonged
reduce

Question 10

Auscultation of Mitral Valve Prolapse:
Supine/squatting moves systolic click (closer to/further from) S1 and the murmur is (shortened/prolonged) due to (increase/decrease) in ventricular volume.

Answer 10

further
shortened
increase

Question 11

Which of the following does NOT increase volume of the left ventricle?
A. Squatting
B. Tachycardia
C. Propranolol
D. Vasopressors

Answer 11

B. Bradycardia

Question 12

Which of the following does NOT decrease volume of the left ventricle?
A. Standing
B. Supine
C. Valsalva
D. Tachycardia
E. Amyl nitrite

Answer 12

B

Question 13

T/F: The majority of pts w/ Mitral Valve Prolapse have a benign course with no symptoms.

Answer 13

True. 85-97%

Question 14

T/F: The majority of pts w/ Mitral Valve Prolapse will show cardiomegaly on CXR

Answer 14

False. Will usually be within normal limits

EKG will usually also be normal

Question 15

T/F: Echocardiogram alone can be used to diagnose Mitral Valve Prolapse.

Answer 15

False. Need an atypical PE also

Question 16

What would you hear upon auscultation of Chronic Mitral Regurgitation?

Answer 16

Holosystolic, “blowing”, best heart at apex w/ radiation to axilla

Sometimes:
Ventricular gallop (S3)
Diastolic “flow rumble” = severe regurgitation

Question 17

T/F: PE of chronic severe mitral regurgitation will have apical impulse that move out laterally byound midclavicular line toward the anterior axillary line

Answer 17

True

Question 18

T/F: CXR of chronic severe mitral regurgitation will appear normal

Answer 18

False. Enlarged left ventricular shadow + signs of enlarged left atrium.
No or only mild evidence of pulmonary vascular congestion (heart failure)