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Cardiovascular > EXAM #2: MITRAL VALVE DISEASE > Flashcards

EXAM #2: MITRAL VALVE DISEASE Flashcards

1
Q

What causes mitral regurgitation?

A

1) Rheumatic Heart Disease
2) Infective Endocarditis
3) Collagen-vascular disease
4) Cardiomyopathy
5) IHD
6) MVP

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2
Q

What valve structures are involved in mitral regurgitation?

A
  • Leaflets
  • Mitral annulus
  • Chordae tendinae
  • Papillary muscles

*Note that the annulus is what the leaflets are attached to

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3
Q

What disease processes will effect the mitral leaflets leading to MR?

A

1) Chronic Rheumatic Heart Disease

2) Infective Endocarditis

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4
Q

What disease processes will effect the mitral annulus leading to MR?

A

1) Dilation
2) Calcification
- More common in women

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5
Q

What disease processes will effect the mitral chordae leading to MR?

A

1) Infective endocarditis
2) Trauma

*Note that this can lead to ACUTE MR–which is really bad

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6
Q

What disease processes will effect the mitral papillary muscles leading to MR?

A

Ischemia

*Note that the posterior papillary muscle is more frequently involved

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7
Q

Why is acute MR an emergency?

A
  • Pulmonary circulation is exposed to LV pressures

- Causes acute pulmonary edema

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8
Q

Why don’t patients with chronic MR develop pulmonary edema?

A

Over time the pulmonary circulation is able to adapt

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9
Q

What happens to the “impedance to LV ejection” i.e. afterload in MR?

A

Afterload is LOWERED

*BUT this causes dilation of the LV when the blood comes back from the pulmonary circulation and increases LV wall-tension

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10
Q

What happens to the EF with time in MR?

A 
Early= high 
Late= low to normal
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11
Q

What happens to the left atrial pressure in MR?

A

Increased

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12
Q

What is the principal symptom of MR?

A

Dyspnea

  • Exertional at first
  • PND or orthopnea later
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13
Q

What are the 3x PE findings that are seen in MR?

A

1) Sharp/severe carotid pulses (higher SV)
2) Apical impulse is:
- hyperdynamic
- displaced left and downward
3) LA thrust at left parasternal area*

Filling of the LA during systole pushes the heart foward into the chest wall

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14
Q

How does S1 change in MR?

A

Soft

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15
Q

How does S2 change in MR?

A

Wider splitting and lound P2

*Aortic sound is earlier than normal

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16
Q

What is a common extra heart-sound associated with MR?

A

S3 b/c the LV is over-filled during diastole

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17
Q

How is the classic MR mumur described?

A

1) Holosystolic (S1-S2)
2) Level contour i.e. no cescendo/decrescendo
3) Radiates to axilla/ back

18
Q

What correlates with the severity of a heart mumur?

A

Duration, NOT intensity

19
Q

How is MR diagnosed?

A

Echocardiography

20
Q

How can severity of MR be quantified?

A

Echo + doppler

21
Q

What ECG changes may be seen with MR?

A

1) LAE*
2) RVH
3) A-fib

22
Q

How is MR treated medically?

A

1) Treat LV failure
- Afterload reudction
2) Anticoagulate A-fib
3) Digitalis
4) Prophylaxis against infective endocarditis

23
Q

What are the drugs of choice to reduce LV afterload?

A

ACEI

24
Q

What is the treatment for acute MR?

A

Nitroprusside + Dobutamine

25
Q

How is MR repaired surgically?

A

1) Valve repair

2) Valve replacement

26
Q

What is the primary etiology of mitral stenosis (MS)?

A

Rheumatic Fever

27
Q

What is the normal size of the mitral orifice?

A

4-6 cm

28
Q

What is the size of the mitral orifice in mild MS and critical MS?

A

Mild= 2cm

Critical= 1cm or less

29
Q

Describe the hemodynamic sequelae of having a stenoic mitral valve.

A

1) Increased pressure gradient to maintain CO
- LA pressure is ALWAYS higher than LV
2) Increased LA pressure= increased pulmonary pressure

30
Q

What may be the first symptom of MS?

A

Systemic embolization

I.e. CVA (50% of the time)

31
Q

What are the signs of MS on PE?

A

1) Mitral facies
2) Arterial pulses low/normal
3) Apical impulse inconspicuous to absent

32
Q

How does S1 change in MS?

A

S1 is LOUD

33
Q

How does S2 change in MS?

A

P2 is later and louder

34
Q

When does the opening snap occur in MS?

A

Between P2 and S3

35
Q

Describe the classic mumur heard in MS?

A
  • Low-pitched, rumbling
  • Apex
  • Opening snap
36
Q

What is a Graham-Steel mumur?

A

Sign of severe pulmonary HTN

37
Q

What is the cornerstone of diagnosis in MS?

A

Echocardiography

38
Q

What ECG changes are seen with MS?

A

1) LAE
2) RVH
3) A-fib

39
Q

Where does MS have a shorter natural history?

A

Tropics

In India it can be critical in childhood

40
Q

How is MS treated?

A

1) Prophylaxis against endocarditis
2) Avoid strenuous exercise
3) Anticoagulant
4) NSR
5) Reduce salt and water intake

41
Q

What is the definitive treatment for MS?

A

Valve replacement

Cardiovascular (38 decks)

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