Mitral and Tricuspid Valve Disease

Question 1

Mitral valve:

Answer 1

• opens in diastole, allowing blood to flow from the LA to the LV
• closes in systole to prevent blood from flowing backwards

Question 2

Tricuspid Valve:

Answer 2

• opens in diastole to allow blood to flow from the RA to the RV
• closes in systole to prevent blood from flowing backwards

Question 3

most common causes of mitral valve disease

Answer 3

• Mitral stenosis = Rheumatic MS (80%), calcific MS, obstruction, prosthetic valve, congenital
• Mitral Regurgitation = blood flows backwards due to abnlity of any component of the MV apparatus
• –prolapse, ischemic heart disease, endocarditis, rheumatic valve disease, LV enlargement

Question 4

most common causes of tricuspid valve disease

Answer 4

• Tricuspid Regurgitation = structural abnormality in the TV, acquired and functional (80%)
• Tricuspid Stenosis = rare, rheumatic heart disease

Question 5

clinical presentation of mitral stenosis

Answer 5

dyspnea, hemoptysis, pulmonary HTN, R sided HF, A fib, thromboembolic event

• –PEx: loud S1, S2, opening snap and diastolic rumble
• –EKG: LA enlargement, LVH if pulm HTN has developed, afib
• –ECHO: LA enlargement, restricted opening of MV during diastole, thickened MV leaflets, severity can be estimated by pressure gradients (Doppler or planimetry)

Question 6

clincal presentation of mitral regurgitation

Answer 6

holosystolic murmur heard at the apex, midsystolic click due to sudden tensing of the chordae tendineae and mitral leaflet, followed by a late systolic murmur,

• –nly asx
• –Pulm edema, pulm HTN
• –CHF: dyspnea on exertion, orthopenea, paroxysmal nocturnal dyspnea, edema

Question 7

clinical presentation of tricuspid regurtiation

Answer 7

murmur (louder with inspiration), JVD, hepatosplenomegaly (90%), systolic pulsation of the liver, holosystolic murmur on sternal border
—fatigue, abd fullness, edema, palp, hepatic congestion/dysfn

Question 8

clinical presentation of tricuspid stenosis

Answer 8

murmur (like M stenosis but closer to the sternum and intensifies with inspiration), dyspnea and edema, occurs with mitral stenosis

Question 9

tx of mitral valve stenosis

Answer 9

Beta blockers, diuretics to tx CHF sx, anticoagulants to tx afib
—mitral valve replacement (bioprosthetic and mechanical), percutaneous balloon mitral valvuloplasty

Question 10

tx of mitral valve regurgitation

Answer 10

meds: diruetics for CHF, afterload reduction (ACEIs, ARBs)
- –surgery (MV replacement or repair)
- –Mitraclip

Question 11

tx of tricuspid valve regurgitation

Answer 11

functional: tx underlying cause of the RV pressure/overload

- –diuretics, surgery (tricuspid repair or replacement)

Question 12

tx of tricuspid valve steonsis

Answer 12

diruetics and surgery