Mitral and Tricuspid Valve Disease

Question 1

Normal function of the Mitral valve

Answer 1

Opens in diastole, allowing blood to flow from l atrium to l ventricle

Closes in systole preventing blood from flowing backwards form l. ventricle to l. atrium

Question 2

Mitral stenosis

Answer 2

Decreased mitral valve opening = flow obstruction. Increased pressure in LA, pulmonary vasculature and R heart

Most often from Rheumatic Heart Disease

Clinically presents: Dyspnea, hemoptysis, pulmonary hypertension and R. sided heart failure with edema and ascites due to liver backup. A fib and thromboembolic events can also happen.

Question 3

Acute Rheumatic Fever

Answer 3

Inflammatory condition involving heart, skin, and connective tissues

Complications of URI by group A Step
Inflammation of the heart can occur (presents often 10-30 years after initial infection)

Question 4

Cardiac Auscultation of Mitral stenosis

Answer 4

• Loud S1
• Opening snap following S2 due to opening of stenotic leaflets
• Diastolic rumble

Question 5

Mitral stenosis treatment

Answer 5

Beta blockers to slow heart rate (allows more time for blood to cross the mtiral valve in diastole)

Diuretics to treat HF symptoms

Anticoagulats if afib present because there could be lots of blood stasis

Mitral valve replacement with either bioprosthetic valves (last 10 years) or mech valves (last 30 years)

OR! Percutaneous balloon mitral valvuplasty

Question 6

Mitral regurgitation

Answer 6

Inadequate mitral valve closure, blood flows backwards from the left ventricle to left atrium during systole

Can be caused by abnormality is any part of the valve
Myxomatous degeneration: mitral valve prolapse
Ischemic heart disease: papillary muscle dysfunction or rupture
Endocarditis: valve deformity, perforation
Rheumatic heart disease
LV enlargement

Question 7

Mitral regurgitation physical exam

Answer 7

Holosystolic murmur between S1 and S2, best heard at the apex.

Mitral valve prolapse: midsystolic click.

Question 8

Mitral valve prolapse

Answer 8

often asymptomatic, often benign with a good prognosis, may develop mitral regurgitation over time

Question 9

Mitral regurgitation clinical presentation

Answer 9

Congestive heart failure - dyspnea on exertion, orthopnea, paroxysmal nocturnal dyyspnea, and edema

Question 10

Mitral regurgitation treatment

Answer 10

diuretics for HR and afterload reduction with ACE and ARBs

Surgery - mitral valve repair/replacement

Mitraclip!

Question 11

Tricuspid valve

Answer 11

Opens in diastole to allow blood to flow from RA to RV

Clsoes in systole to prevent blood in the RV to flow backwards into RA

Question 12

Tricuspid regusgitation

Answer 12

During systole, doesn’t close adequately and blood flows backwards. INcreased venous pressure, so LE edema, ascites, hepatic congestion.

Most causes are functional -> annular dilation and leaflet tethering.

Question 13

Tricuspid regurgitation physical exam findings

Answer 13

Jugular venous distension with visible systolic v wave

Hepatomegaly

Fatigue, abdominal fullness, edema, palpitations

Question 14

Tricuspid regurgitation treatment

Answer 14

Treat underlying cause if functional
Diuretics, or tricuspid repair. Don’t usually do this unless person is also going in for left sided valve repair surgery.

Question 15

Tricuspid stenosis

Answer 15

VERY RARE! Usually from rheumatic heart disease (remember, mitral > tricuspid)

Murmur is similar to the mitral stenosis one but heard closer to the sternum and intensified with inspiration

Dyspnea and edema, often simultaneous with mitral stenosis.

Use diuretics or surgery