mitral regurgitaion

Question 1

etiology? acute vs chronic MR?

Answer 1

degenerative mitral valve dx (mitral valve prolapse)
rheumatic fever
infective endocarditis
papillary muscle rupture after MI

acute MR leads to volume overload and acute heart failure
chronic MR leads to cardiac remodeling to compensate, eventually causing HF

Question 2

pathophysiology of acute and chronic?

Answer 2

acute: increase in LA volume and LV end diastolic volume -> sudden increase in LA pressure -> backflow of blood into lungs with pulmonary congestion

chronic: progressive LV hypertrophy -> high LV volume capacity -> maintain SV and CO -> eventually the LVH leads to HF

Question 3

clinical features?

Answer 3

palpitations, signs of LHF

soft S1, normal S2
added S3
holosystolic murmur at apex radiating to axilla
hyperdynamic apex (displaced due to LVH)

Question 4

diagnosis?

Answer 4

echocardiography

ecg can show LVH
chest xray can show pulmonary edema and lvh

Question 5

treatment?

Answer 5

HF: ACEI and loop diuretics
surgery: valve replacement if acute, valve repair if chronic

Question 6

mitral valve prolapse murmur, movements, and seen in which dx?

Answer 6

seen in marfan

murmur: mid systolic click with late systolic murmur

from squat to stand: murmur increase in intensity and click decrease
from stand to squat: murmur decrease in intensity and click increases