Mitral and Tricuspid Valve Disease Flashcards
Forms of valve disease
Regurgitation (Insufficiency)
Stenosis
Components of mitral valve
Annulus
leaflets
chordae
Papillary muscle
What is the mitral annulus?
Fibrous structure that supports the valve in the atrial ventricular grove. Not planer - hyperbolic paraboloid
Describe the shape of the mitral annulus
saddle shaped
Possible mitral valve pathology
- Regurgitation: Functional & Myxomatous disease
- Stenosis: rheumatic
Primary mitral valve disease
- Myxomatous: associated w/ connective tissue disease, hereditary, results in prolapse, redundancy and valve incompetence
- Endocarditis, chordae rupture
Mitral valve prolapse show a Long __________ course
asymptomatic
Mitral valve prolapse - sequlae
Left atrial enlargement (Afib)
Left ventricle volume overload (Dilation & dysfunction)
Heart Failure symptoms
Risk of endocarditis
What is heard upon auscultation of a mitral valve prolapse pt?
Mid systolic click
Late diastolic or holosystolic murmur (classically in apex)
Maneuvers that modify the murmur resulting from a mitral prolapse:
- intensify and prolong the Murmur: Decrease LV size (Valsalva, dehydration)
- decrease murmur: Increase LV size (Squatting, Hydration)
Myxomatous mitral valve Treatment
- Surgical treatment: repair or replacement
- Medical treatment: After-load reduction (reduce systemic BP), Treatment of CHF symptoms (diuretics), not very effective
causes of functional mitral valve regurgitation?
-Primary a Left ventricle problem:
Restriction of the Leaflets
Tethering of the chordea
Dilatation and flattening of the annulus
what physical findings do you find on a Functional Mitral Regurgitation pt?
-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
Functional Mitral Regurgitation Treatment
-Medical Treatment,Treat the underlying cardiomyopathy: ACEI Beta-blockers Spironolactone Revascularization Bi-Ventricular Pacing Transplant -Primary Mitral Valve Surgery – Controversial
what is mitral stenosis?
Restricted opening of the Mitral valve from a chronically thickened valve
Major cause of mitral stenosis?
Rheumatic Heart Disease, Rarely senile Calcification
Mitral Stenosis -sequlea
- Long asymptomatic period
- Left atrial enlargement (can be massive): a fib, clots, stroke
- Heart failure symptoms
- Pulmonary hypertension
physical findings in mitral stenosis?
– Loud S2 – Opening snap – Diastolic rumble At apex – Signs of pulmonary hypertension: Loud P2, RV thrill &JVD Tricuspid regurgitation murmur
Treatment of mitral stenosis
-Valvuloplasty
-Surgical replacement
-medical Tx: Not curative
– Beta blockers
– Diuretics (to treat heart failure) – Anticoagulation
– Antibiotics
Tricuspid valve anatomy
3 leaflets
3 papillary muscles
Types of tricuspid valve disease
-Tricuspid Regurgitation: 2dary to HF or Pulm HTN
-Primary Tricuspid Valve disease is rare
– Congenital heart disease (Epstein’s Abnormality)
– Endocarditis
– Carcinoid
– Rheumatic
what is associated with underlying RV disease and pulmonary hypertension?
Tricuspid Regurgitation
physical findings of Tricuspid Regurgitation?
-Holosystolic Murmur:
Left lower sternal border
Increases with inspiration
Loud P2 (with pulmonary hypertension)
epidemiology of Tricuspid Stenosis
rare, Carcinoid syndrome
Tricuspid Stenosis - Sequlea
Right heart symptoms: JVD, edema, hepatic congestion
physical findings of tricuspid stenosis
Diastolic murmur at Left lower sternal border – Increases with inspiration
