(MHD) Clinical Valvular Heart Disease Flashcards
What is the primary cause of mitral stenosis?
Rheumatic fever (rare in the US)
How does rheumatic fever lead to mitral stenosis?
It results in “melting” and fusing of the mitral valve apparatus. The leaflets become so rigid that they cannot open or shut
What effect can rheumatic fever have that leads to Mitral Regurgitation?
When rheumatic fever results exclusively or predominantly in contraction and fusion of the chordae tendineae, with little fusion of the valvular commissures, dominant MR results
Name the clinical presentations which may result from chronic MS (8)
- Enlargement of the left atrium and resultant elevation of the left main stem bronchus
- Calcification of the left atrial wall
- Mural thrombi
- Obliterative changes in the pulmonary vascular bed
- Dyspnea
- Pulmonary Edema
- Endocarditis
- Compression of the left recurrent laryngeal nerve
A “Hockey-stick” deformity on ultrasound is associated with what cardiac issue?
Mitral Stenosis
What operation is the key for mitral stenosis treatment?
Balloon valvulopasty
Carried out in symptomatic patients with moderate to severe MS
What is the most common valvular issue?
Mitral Valve regurgitation
Degenerate vs Functional Mitral Regurgitation
Degenerate: The valve itself has broken down in a way that can be fixed
Functional: The issue is not with the valve itself so much so as with the ventricle. Much tougher fix.
How can ischemia/infarction lead to mitral regurg?
Ischemia/Infarction can lead to a failure of papillary muscle contraction, thus allowing for prolapse into the atria and associated insufficiency.
Why might atrial dilation or left ventricular hypertrophy be seen with mitral regurgitation?
- If the left atrium doesn’t expand in size, you will see RV hypertrophy because blood which is regurgitated into the left atrium backs up and causes a pressure increase for the right ventricle to push through.
- Sometimes the atria simply dilates and there are no pressure changes.
Symptoms usually do not develop in patients with chronic MR until __________________. Because of this….
The left ventricle fails.
Because of this, we cannot wait for symptoms
_______________ reduction is of particular benefit in the management of mitral valve regurgitation– both the acute and the chronic forms.
Afterload reduction
What window defines the optimal timing of valve replacement surgery?
If the surgery is done too early, the patient will have a valve for a longer time and as such will have greater risk for longterm prosthetic complications.
If surgery is done too late, the Left Ventricle gets too stretched out and ventricular function is too deteriated.
The patient’s _______ prior to surgery is a good predictor of surgical outcome
EF
What kind of valve is normally given to younger patients? Elderly?
Younger: mechanical valve
Elder: tissue based valve (porcine, bovine, etc.)