Mitral Regurg Flashcards
Signs and symptoms
Asymptomatic or mild symptoms Sob- pulmonary congestion Fatigue- low cardiac output Palpitation- AF /LV dysfunction Fluid retention Check hx of RF, ENDO, MI
Exam
Apex best displaced First heart sound soft Pansystolic murmur HS3 Left parasternalheave
Causes of chronic regurg
Infective endo Mitral valve prolapse Rheumatic heart disease Left ventricle dilation Coronary artery disease Cardiomyopathy Papillary muscle dysfunction
Causes of acute mitral regurg
Acute MI
endocarditis
Trauma
Myxomatous degeneration of valve
Investigations and results
ECG; broad bifid p waves, LVH, AF
CXR: pulmonary congestion, large heart, LAH,PA enlargement
Echo; anatomy, volume, ejection fractions
TOE; better to visualise mitral valve
Differences between MR TR
PULSE JVP PALPATION AUSCULTATION OTHER
MR JERKY/ normal Prominent v wave LV heave Pansystolic murmur- radiates to axillary Hepatic pulsation
TR NORMAL NAD JVP LEFT PARASTERNAL HEAVE PANSYSTOLIC INCREASES INSPIRATION
Jerky pulse
Reduced ejection time, Blood regurg into LA
Causes of pansystolic murmur over precordium
Mitral reg
Tricuspid reg
VSD- radiate to right sternum
Congenital cardiac conditions associated with MR
Osmium primula defect
Partial av canal
Corrected transposition of the great arteries
Mechanisms of MR
Functional : valve deformation caused by ventricle remodelling
Organic: intrinsic valve lesions
Determine severity of lesion
Larger LV on exam worse the lesions
HS3 disease is severe
Colour Doppler
Prognosis worse if RV volume is reduced.
Cause of HS 3
Rapid ventricular filling
Mgmt asymptomatic patient
Mild; annual echo and visit
Moderate: same
Severe; 6months echo and work up maybe exercise testing
Antibiotic prophylactix endo
Surgery?
Indications for surg
Moderate to severe symptoms
Ejection fractuion less 60%
Successful repair less likely if
Aetiology is ischemic infectious rheumatic signif calcification
