mitral regurg + bits Flashcards
name and describe valve pathologies
stenosis - limit forward flow - really tight valves
regurgitant - let flow back through and are no longer one way
mixed - can be both stenotic and regurgitant
most common clinically important valve disease
aortic stenosis
which is pressure and which is volume loaded
stenosis - chamber before valve eg LV for aortic valve is described as pressure loaded
regurgitation - the chamber before the valve eg LA if mitral valve is described as volume loaded
causes of primary mitral regurgitation and what is primary
abnormal leaflets - mitral valve prolapse:
Infectious causes
Congenital causes
Calcification/degenerative
rupture of chordinae
causes of secondary mitral regurgitation and what secondary is
abnormal structures around mitral valve:
Ischaemic causes – post-infarct - look for recent history of MI
Cardiomyopathy - disease of myocardium
chronic mitral regurgitation
- Left atrium dilates as volume overloaded
Back pressure into pulmonary then right heart circulation causing peripheral oedema
LV dilates as also volume overloaded and eventually function becomes impaired
LV usually preserved for 10-15 years
Once symptoms develop or LV function deteriorate it’s time to intervene
when should you consider surgical intervention with MR?
Once symptoms develop or LV function deteriorate it’s time to intervene
acute mitral regurgitation
Acute MR is life threatening emergency as the LV has not had time to adapt
Can be a complication of acute coronary syndrome and confers poor prognosis but reperfusion can dramatically improve mitral valve function
Urgent surgery usually required
mitral regurg medical management
- diretics and heart failure therapy
- manage AF - anticoag - bc AF causes turbulent flow
- any sumptoms of LV failure on echo - refer for consideration of intervention
- if they dont have symtpoms consider exersize stress testing
mitral regurg interventional management
- first line - repair of existing valve
- use scaffold to support existing valve
- reduces risk of clot and infection
second line - if cant be repaired - mechanical or bioprosthetic
- higher INR targets with warfarin for mitral that aortic
transcatheter repair
mitral regurgitation associated conditions
- dilation of LA causes atrial fibrillation which is seen in many patients with MR
- rheumatic heart disease (post streptococcal) most common worldwide in non-developed countries - check if they have been travelling / born elsewhere than uk
- MR more common in connective tissue disease
mitral regurgitation symptoms
- palpitations
- shortness of breath on exertion
- peripheral oedema, orthopnoea, paroxysmal nocturnal dyspnoea
I wouldn’t expect chest pain or postural syncope
mitral regurg signs
- AF - irregular heart beat
- peripheral oedema
- raised JVP - jugular venous pressure
- apex beat displaced into the axilla and perhaps life-sided
- systolic murmur - loudest at 5th intercostal space midclavicular line
mitral regurg investigation
- ECG
- echocardiogram
- transoesophageal echo - gain pictures
Tricuspid Regurgitation – An overview
- Very commonly secondary to other problems
- poor prognostic in heart failure
- caused by endocartditis and carcinoid syndrome
nmemonic for if the murmurs are systolic or diastolic for each valve
ASMR - systolic
AMSR - diastolic
