Mitral and Tricuspid Valve Disease

Question 1

Forms of valve disease

Answer 1

Regurgitation (Insufficiency)

Stenosis

Question 2

Components of mitral valve

Answer 2

Annulus
leaflets
chordae
Papillary muscle

Question 3

What is the mitral annulus?

Answer 3

Fibrous structure that supports the valve in the atrial ventricular grove. Not planer - hyperbolic paraboloid

Question 4

Describe the shape of the mitral annulus

Answer 4

saddle shaped

Question 5

Possible mitral valve pathology

Answer 5

• Regurgitation: Functional & Myxomatous disease

- Stenosis: rheumatic

Question 6

Primary mitral valve disease

Answer 6

• Myxomatous: associated w/ connective tissue disease, hereditary, results in prolapse, redundancy and valve incompetence
• Endocarditis, chordae rupture

Question 7

Mitral valve prolapse show a Long __________ course

Answer 7

asymptomatic

Question 8

Mitral valve prolapse - sequlae

Answer 8

Left atrial enlargement (Afib)
Left ventricle volume overload (Dilation & dysfunction)
Heart Failure symptoms
Risk of endocarditis

Question 9

What is heard upon auscultation of a mitral valve prolapse pt?

Answer 9

Mid systolic click

Late diastolic or holosystolic murmur (classically in apex)

Question 10

Maneuvers that modify the murmur resulting from a mitral prolapse:

Answer 10

• intensify and prolong the Murmur: Decrease LV size (Valsalva, dehydration)
• decrease murmur: Increase LV size (Squatting, Hydration)

Question 11

Myxomatous mitral valve Treatment

Answer 11

• Surgical treatment: repair or replacement
• Medical treatment: After-load reduction (reduce systemic BP), Treatment of CHF symptoms (diuretics), not very effective

Question 12

causes of functional mitral valve regurgitation?

Answer 12

-Primary a Left ventricle problem:
Restriction of the Leaflets
Tethering of the chordea
Dilatation and flattening of the annulus

Question 13

what physical findings do you find on a Functional Mitral Regurgitation pt?

Answer 13

-Holosystolic murmur at apex: Quiet S1
-Signs of LV dysfunction:
S3, S4
Loud P2 – associated with Pulmonary Hypertension
Lateral displacement of the apical impulse Edema, crackles, Jugular venous distension

Question 14

Functional Mitral Regurgitation Treatment

Answer 14

-Medical Treatment,Treat the underlying cardiomyopathy:
ACEI
Beta-blockers 
Spironolactone 
Revascularization 
Bi-Ventricular Pacing 
Transplant
-Primary Mitral Valve Surgery – Controversial

Question 15

what is mitral stenosis?

Answer 15

Restricted opening of the Mitral valve from a chronically thickened valve

Question 16

Major cause of mitral stenosis?

Answer 16

Rheumatic Heart Disease, Rarely senile Calcification

Question 17

Mitral Stenosis -sequlea

Answer 17

• Long asymptomatic period
• Left atrial enlargement (can be massive): a fib, clots, stroke
• Heart failure symptoms
• Pulmonary hypertension

Question 18

physical findings in mitral stenosis?

Answer 18

– Loud S2
– Opening snap
– Diastolic rumble At apex
– Signs of pulmonary hypertension: Loud P2, RV thrill &JVD
 Tricuspid regurgitation murmur

Question 19

Treatment of mitral stenosis

Answer 19

-Valvuloplasty
-Surgical replacement
-medical Tx: Not curative
– Beta blockers
– Diuretics (to treat heart failure) – Anticoagulation
– Antibiotics

Question 20

Tricuspid valve anatomy

Answer 20

3 leaflets

3 papillary muscles

Question 21

Types of tricuspid valve disease

Answer 21

-Tricuspid Regurgitation: 2dary to HF or Pulm HTN
-Primary Tricuspid Valve disease is rare
– Congenital heart disease (Epstein’s Abnormality)
– Endocarditis
– Carcinoid
– Rheumatic

Question 22

what is associated with underlying RV disease and pulmonary hypertension?

Answer 22

Tricuspid Regurgitation

Question 23

physical findings of Tricuspid Regurgitation?

Answer 23

-Holosystolic Murmur:
Left lower sternal border
Increases with inspiration
Loud P2 (with pulmonary hypertension)

Question 24

epidemiology of Tricuspid Stenosis

Answer 24

rare, Carcinoid syndrome

Question 25

Tricuspid Stenosis - Sequlea

Answer 25

Right heart symptoms: JVD, edema, hepatic congestion

Question 26

physical findings of tricuspid stenosis

Answer 26

Diastolic murmur at Left lower sternal border – Increases with inspiration