L32 Flashcards
Cause of mitral stenosis
Rheumatic heart disease
Pathophys and symptoms of mitral stenosis
Stiff valve - less blood into LV More pressure in the LA --> higher pulm pressures Symptoms = CHF - DOE - Fatigue - SOB - Orthopnea/PND
So what kind of HF does mitral stenosis cause?
HF w/ normal LV filling pressure
The exception to the rule since all other HFs have this
Does the LA change size due to mitral stenosis? What do said changes increase the risk of?
Dilation b/c high P
Higher risk AFib
Which ventricle is more likely to fail with mitral stenosis
RV
How do these factors change throughout mitral stenosis
- Arterial pulse
- Apical impulse
- JVP
All normal! Until... develop pulm HTN 1. Loud P2 arterial pulse 2. RV heave 3. Large "a" wave in JV pattern
Mitral stenosis auscultation - 3 pts
- Opening snap = stiff valve opens, after S2
- Diastolic (after S2) low pitched murmur
- Loud S1
“Lubb dup dup purr”
What might be included in the diastolic mitral stenosis murmur?
Pre-systolic accentuation - gets louder closer to systole
Best place to hear MS
L lateral decubitus
Scan images for MS
LA dilated/enlarged
RV hypertrophy
**STRAIGHT heart border +/- elevated L bronchi +/- esophagus out of the way
3 pts of mitral valve stenosis treatment
- Decrease LA pressure - diuresis
- Manage AFib
- Meds to prevent clots
2 surg options for MS
Commissurotomy
Replacement
Primary mitral regurg
Pathology of valve componenets
Secondary mitral regurg
1ary problem = dilated LV
2ary problem is dilation means valve won’t close correctly
Pathophys mitral regurg
LV blood –> LA b/c lower P here
LV sees larger vol load b/c = diastolic filling + reflux blood from LA
Increase LV stroke volume to get the normal amt of blood into aorta while losing some to LA = DILATION
What is EF good or bad for dilated heart under volume overload?
Good = high EF
Is EF good or back for pumping if b/c of cardiomyopathy or ESRD
Bad pump = low EF
LA and LV size and pressures in acute MR
Normal LV and LA size
High pressure in LA due to higher volume in same sized atria - P reflected in lungs
LA and LV size and pressures for chronic MR
LA & LV dilated
Pressures are normal due to dilation over time to accommodate sustained pressures due high volume
Presentation MR
CHF
3 findings of MR auscultation
- Holosystolic murmur = bet S2-3
- S3
- Palpable hyperdynamic apex
What shows in cath lab for MR
V wave in cap wedge position
Treat acute vs chronic MR
Acute - IV nitroprusside + intra-aortic balloon
Chronic - vasodilate PO
2 surg options for MR
Repair
Replace
Mitral prolapse pathphys
Less collagen/elastin
More myxomatous - looser tissue in valve
- Inherited degenertation
What dictates the symptoms of mitral prolapse
Degree of associated MR
Aka common for regurg to develop 2ary
Auscultation for mitral prolapse
Mid-late systolic click
Late systolic murmur
CHANGES w/ MANEUVERS
What type of mitral prolapse do you treat?
Ruptured chordae -> flailing leaflet
Acute, severe
