Mitral Regurg

Question 1

Causes of mitral regurg:

Answer 1

• rheumatic disease
• infective endocarditis
• collagen-vascular disease
• cardiomyopathy (esp dilated)
• ischemic heart disease (papilary muscle dysufnction
• mitral valve prolapse (valve to big for the annulus - a bit floppy)

Question 2

leaflets of Mitral valve involved in MR when:

Answer 2

• chronic rheumatic disease (more common in men)

- infective endocarditis

Question 3

Mitral annulus of mitral valve involved in MR when:

Answer 3

• dilation of LV
• calcification - idiopathic, most common in women

(the valve doesnt fit in the annulus anymore)

Question 4

chordae tendinae of mitral valve involved in MR when:

Answer 4

• mitral valve prolapse = lengthened and ruptured

- infective endocarditis, trauma,

Question 5

papillary muscles of mitral valve involved in MR when:

Answer 5

• frequent cause of MR –> ischemia (RIGHT CORONARY) and rupture
• POSTERIOR PAPILLARY MOST OFTEN INVOLVED
• rupture of papillary muscle during MI is fatal

Question 6

Pathophys of mitral regurg:

Answer 6

• impedance to LV ejection (ie afterload) is lowered in MR\
• starts out ok but overtime the LV cant compensate anymore = dilation and excess volume is maintained by the LA and pulmonary circulation

Question 7

physical symptom of mitral regurg?**

Answer 7

Dyspnea

-exertional at first then later PND or orthopnea

Question 8

Physical exam - mitral regurg?

Answer 8

• carotid artery pulses sharp
• apical impulse - brisk/hyperdynamic - displaced left and down
• occasional late-systolic LA thrust palpable at left parasternal area

Question 9

Mitral regurg on auscultation:

Answer 9

• *-S1 is soft if mitral valve leaflets are flexible
• *-S2 wide split due to earlier A2
• A2 is softer than P2 with pulmonary HTN
• *-S3 common in LV owing to volume excess
• tricuspid murmur
• S4 in RV (pulmonary HTN)

Question 10

Mitral regurg murmur:

Answer 10

• holosystolic-constant
• BLOWING loudest at apex
• radiates to axilla
• starts S1 through to S2

-some patients have MR with a diastolic murmur beginning with S3

Question 11

Severity of murmur depends on…

Answer 11

DURATION

NOT LOUDNESS!!!

Question 12

BEST option for diagnosis - MR?

Answer 12

Echocardiography

Question 13

MR treatment:

Answer 13

1) if LV failure - reduce aftrload (ACEI)
2) if acute MR (popped some chordae - nitroprusside & dobutamine
3) If hypotensive- dobutaine
4) if in atrial fib- anticoagulants
5) digitalis glycosides - improve inotropism and slow atrial fib
6) prophylaxis against infective endocarditis
7) Surgical treatment!! (valve repair - valve replacement)