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Cardio Module > Mitral regurg/stenosis > Flashcards

Mitral regurg/stenosis Flashcards

1
Q

5 components of mitral valve and heart that can result in mitral disease

A
  1. annulus (calcifies with age or disease)
  2. leaflets (can go bad with infection)
  3. two papillary muscles inserted into LV wall (each with two heads)
  4. chordae
  5. LV wall
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2
Q

Name the commonest etiologies of MR

A
  1. papillary muscle dysfunction
  2. mitral valve prolapse
  3. calcified mitral annulus
  4. Rheumatic heart disease
  5. infective endocarditis
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3
Q

what is functional mitral regurg

A
  • no problem with the mitral valve itself, but have a problem elsewhere (papillary, LV, etc.) that causes same effect as mitral regurg
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4
Q

what is organic mitral regurg

A
  • regurg that’s actually caused by a problem in the valves
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5
Q

Is mitral regurg a LV pressure or LV overload problem?

A
  • volume overload (mitral valve doesn’t work, so when ventricle squeezes, blood is going through back to the left atrium
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6
Q

mitral regurg gives ____ hypertrophy… why?

A
  • eccentric
  • you get LV dilatation and hypertrophy to increase compliance, resulting in incrased EDV without an increase in EDP because of dilation
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7
Q

what is the result of mitral regurg on starling forces?

A
  • increase SV and ejection fraction early
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8
Q

What is the pro and con of dilated LA

A

pro: prevents increase in Pulmonary artery pressure
con: over time, no forward CO, resulting in thrombi formation

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9
Q

carotid impulse is caused by 2 events?

so what happens with carotid impulse is MR?

A
  1. volume of blood coming out of ventricle
  2. speed with which volume comes out
  • carotid feels normal because of our dilation, which with starling forces increases our contractility and actually increases the EF
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10
Q
  • describe apex impulse of MR
A
  • inferolaterally displaced and enlarged
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11
Q

4 types of MR murmurs and what they correspond to

A
  1. holosystolic: rheumatic heart disease
  2. late systolic: mitral valve prolapse
  3. midsystolic: papillary muscle dysfunction
  4. decrescendo: acute mitral regurg
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12
Q

if you hear murmur at apex, assume:

A

mitral regurg

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13
Q

cxr finding in chronic mr

A
  • enlarged pericardial silhouette due to large left atrium
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14
Q

EKG finding of MR

A
  • atrial dilation causes atrial dysfunction… gives us afib and potentially LVH
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15
Q

clinical signs of severity:

A
  • fatigue/congestion over time
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16
Q

why would LV dilate?

A
  • even though mitral regurg is sending blood back to LA, that blood is eventually going to go to LV, causing a volume overload and dilation
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17
Q

bedside exam indications of MR

A
  • displaced apex
  • loud systolic murmur at the apex
  • potentially mid-diastolic rumble + S3
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18
Q

name etiologies of acute mitral regurg

A
  • ischemia
  • endocarditis
  • trauma
  • torn chordae (MVP)
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19
Q

what is acute mr and hemodynamic effect

A
  • sudden increase in volume on unprepared LV; because LA is not compliant, the blood shot back into Left atrium cant be dealt with, causing marked PAH, with decreased SV and CO
20
Q
  • acute MR :

history

bedside findings

A
  • sudden onse SOB +/- chest pain
  • apex impulse is at normal location, but see parasternal lift because of that RIGHT VENTRICLE dialtion because you have backup , still hear that systolic murmur at the apex
  • HEAR S4 due to atrial kick with high output

you can hear P2 and give widened splitting(?)

21
Q

what is the anatomy dysfunction of MVP

A
  • leaflets billow into LA during systole due to floppy chordae tendinae
22
Q
  • MVP is more common in _____(gender), but more severe in ________ (gender)
A

women; men(tears chordae completely)

23
Q

describe mismatch idea of MVP

A
  • your lv cavity size is normal, but you have elongated, floppy chords
24
Q

What drug can you give to dilate LV?

A
  • beta blocker (decreases contractitlity usually)
25
Q

what sound is important to hear with MVP

A
  • mid systolic CLICK (not ejection), that induces a mid systolic murmur
26
Q

for MVP, increasing LV cavity size does what to murmur?

decreased cavity?

A
  • increased cavity is going to make murmur later/shorter

- decreased cavity is going to make mumur earlier/longer

27
Q

hallmark of mitral stenosis is _______

A

early diastolic murmur

28
Q

Name some etiologies of MS

A
  • acute rheumatic fever
  • narrowing of mitral valve to give decreased area (normal is greater than 4; mild is >1.5, mod is 1-1.5, severe <1.0)
  • fused commisures
29
Q

what proportion of patients with rheumatic heart disease can tell you they had a history of rheumatic fever? what presents?

A
  • 50%
  • in bed with arthritis, miss a lot of school, sick

AUTOIMMUNE

30
Q

Jones criteria mnemonic

A

CANCER

  1. carditis (pancarditis)
  2. arthritis (migratory polyarthralgia)
  3. nodules (subcutaneous nodules
  4. chorea (Syndham’s)
  5. erythema
  6. rheumatic heart disease
31
Q

what is the carditis characterization of RHD

A
  • PANCARDITIS (can affect any layer)
32
Q

describe apical impulse for mitral stenosis

A
  • decreased because of decreased LV volume
33
Q

what are possible results to left atrium for mitral stenosis?

A
  • obstruction of flow from LA-LV, creating a diastolic gradient that can eitehr increase the Left atrial pressure… potentially cause dilation
34
Q

symptoms of mitral stenosis

A
  • dyspnea: pulmonary venous HTN from backup from left atritum… see in moderate cases only with exercise, then at rest
  • orthopnea, sudden acute pulmonary edema
  • decreased CO from decreased lv volume is giving fatigue… definitely problem with Afib
  • palpitations because of Afib because atrium can dilate or not squeeze well
35
Q

characterize carotid pulse of MS

A
  • can’t get a lot of blood out of ventricle… decrease BP systolic, narrow PP
36
Q

what happens wit MS jugular venous pulse

A
  1. giant a wave (trouble getting blood into right ventricle secondary to pulmonary artery hypertension)
  2. giant v wave… because of increased blood going to right atrium (increased right atrial filling)
37
Q

T/F you can feel a strong apical impulse… if False, what are you looking for instead?

A
  • F; parasternal lift
38
Q

Waht is the graham-steele murmur

A
  • loud P2
39
Q

how does murmur of TR vary with respiration

A
  • inspiration makes murmur of TR louder
40
Q

Explain diastolic rumble for MS

A
  • preceded by opening snap (diseased valve like MS makes noise when it opens)
  • diastolic rumble leading into presystolic afccentuation
41
Q

cxr finding and ekg finding of MS

A
  • CXR: big left atrium

EKG: afib

42
Q

catheritization finding between la and lv

A
  • gradient seen between la and lv.. with increased pressure at la due to blockage not allowing great movement to lv
43
Q

5 determinants of MS clinical severity

A
  1. OS relationship to second sound (2-OS interval)
    • if <0.06… higher LA pressure, severe mitral stenosis
  2. length of diastolic rumble
  3. mean gradient (<5 mild; 5-10: moderate; >10 severe
  4. PAP systolic (matches hypertension criteria)

Valve gradient (already seen before)

44
Q

valve gradietn is _______ dependent… so it can be changed via what mechanisms?

A
  • flow;
  • HR
  • BP
  • contractility
45
Q

Name some complications of MS

A
  1. pulmonary arterial hypertension
  2. Right heart failure
  3. afib
  4. thromboemboli (pooling of blood in atrium)
  5. Hoarsness of voice: compression of recurrent laryngeal by LA
46
Q

Name 3 treatment options of MS

A
  1. medical: beta blockers and anticoagulation thearpy… only use diuretics with heart failure
  2. surgery (valve replacement or repair of commissurotomy)
  3. Percutaneous balloon valvuloplasty

Cardio Module (25 decks)

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