mitral and tricuspid dz

Question 1

mitral valve anatomy

Answer 1

1. annulus
2. chordae
3. leaflets
4. papillary muscle

Question 2

Mitral valve function

Answer 2

1. opens in diastole, allowing blood to flow from the LA to the LV
2. closes in systole, preventing blood from flowing backward from the LV to the LA

Question 3

Mitral stenosis is

Answer 3

decreased mitral valve opening, which causes obstruction of the flow from the LA to the LV during diastole

Question 4

mitral stenosis leads to

Answer 4

increased pressure within the LA, pulmonary vasculature and right heart

Question 5

Mitral stenosis: etiology

Answer 5

1. rheumatic MS
2. calcific MS (3%)
3. obstructuve (tumor, like myxoma)
4. prosthetic valve (thrombosis, degeneration)
5. congeital

Question 6

acute rheumatic fever

Answer 6

1. inflammatory condition involving the heart, skin and c.t.
2. complication of URI caused by group a strep
3. ARF occurs 2-3 weeks after the initial throat infection
4. inflammation of the heart occurs

Question 7

rheumatic MS

Answer 7

1. 80% of MS cases are rheumatic

2. only ~50% of pt report a history of rheumatic fever

Question 8

ARF symptoms

Answer 8

chills, fever, migraroty arthralgias, fatigue

Question 9

inflammation of the heart from ARF

Answer 9

1. inflammation of valvular endocardium leads to chronic rheumatic heart disease
2. symptoms of valve dysfunction typically do not manifest for 10-30 years after initial infection

Question 10

mitral stenosis: clinical presentation

Answer 10

1. dyspnea
2. hemoptysis
3. pulmonary hypertension
4. right sided heart failure
5. A fib
6. Thromboembolic event

Question 11

MS dyspnea caused by

Answer 11

↑ in LA pressure → ↑ pulmonary venous capillary pressure → pulmonary edema

Question 12

MS hemoptysis is caused by

Answer 12

↑ pulmonary vascular pressure → rupture of a bronchial vein into lung parenchyma

Question 13

MS: right sided HF is due to

Answer 13

see edema and ascities and it is due to RV working chronically against ↑resistance of pulmonary hypertension

Question 14

MS A-fib is caused by

Answer 14

chronically elevated LA pressure leads to LA dilation

Question 15

MA thromboembolic event is due to

Answer 15

like a stroke is due to stagnant blood flow in the LA may lead to blood clot formation

Question 16

Mitral stenosis: cardiac auscultation

Answer 16

1. loud S1
2. Opening snap
3. diastolic rumble

Question 17

loud S1 is due to

Answer 17

the high AV pressure gradient keeps the MV open until the ventricular systole forcefully closes the valve

Question 18

the opening snap is due to

Answer 18

the opening snap follows S2 and is due to the opening of the stenotic leaflets

the severity of the MS is inversely proportional to the interval between S2 and OS.

Higher LA pressure forces the valve open earlier

Question 19

diastolic rumble is due to

Answer 19

low frequency decrescendo murmur due to turbulent flow across the stenosis valve during diastole

the duration but not the intensity correlates with the intensity of the MS

Question 20

MS: EKG:

Answer 20

1. Left atrial enlargement
2. RVH if pulmonary hypertension has developed
3. atrial fibrillation may be seen

Question 21

MS: echo

Answer 21

1. LA enlargement
2. restricted opening of MV during diastole
3. thickened mitral valve leaflets, fusion of commissures (rheumatic MS)

Question 22

MS severity can be estimated by

Answer 22

measuring the pressure gradient with doppler or by direct visualization (planimetry)

Question 23

MS: grading severity

Answer 23

1. mild
2. moderate
3. severe

by valve area
mean gradient and
PA pressure

Question 24

mean gradient is

Answer 24

pressure difference between LA and LV during diastole

Question 25

mild MS ia

Answer 25

> 1.5 valve area

< 30 PA pressure

Question 26

moderate MS is

Answer 26

1- 1.5 valve area
5-10 mean gradient
30-50 PA pressure

Question 27

severe MS is

Answer 27

10 mean gradient

> 50 PA pressure

Question 28

MS treatment

Answer 28

1. medications
   a. beta blocker to slow HR
   b. diuretics to tx CHF symptoms
   c. Anti-coag if a-fib is present
2. mitral valve replacement

Question 29

MS: Beta blocker tx:

Answer 29

slows HR

slowing HR allows more time for blood to cross the mitral valve in diastole

Question 30

MS: anti-coag tx

Answer 30

if afib is present

MS can cause stasis of blood flow in the LA, which can lead to thrombus formation and stokre