Mitral Regurgitation 2

Question 1

acute MR: hemodynamics curve?

Answer 1

ventricular pressure lower than normal during systole, and atrial pressure way higher (massive v wave), almost approaching ventricular pressure. during diastole LA and LV pressure both higher than normal, atrial kick higher than normal

Question 2

acute MR physical exam: BP? HR? lungs? apex?

Answer 2

BP may be decreased. HR increased. lungs have severe edema = crackles. apex non displaced (since no time for LV to stretch/enlarge)

Question 3

acute MR: heart sounds?

Answer 3

S1/S2 probably normal. S3 from loaded LV filling early in diastole. S4 from stiff LV filling late in diastole during atrial kick. murmur from turbulent LV to LA flow that tapers off as the gradient decreases (during systole)

Question 4

chronic MR: what about it is different from acute?

Answer 4

there is time for LA and lV to dilate; no high pressures into pulmonary system until late into time course

Question 5

chronic MR: what happens to LV filling?

Answer 5

increased LV filling in diastole = increased LV output and contractility. the LV has time to stretch, so higher volume without increased pressure

Question 6

what is the problem for increased LV filling/volume in chronic MR?

Answer 6

more LV wall stress, so increased LV wall thickening to compensate (eccentric LV hypertrophy

Question 7

what can worsen MR (assuming to change in mitral structure)

Answer 7

worsens with increase in systolic LV pressure. so worse with higher aortic BP, or narrowed aortic valve.

Question 8

chronic MR hemodynamics curve?

Answer 8

BP maintained so ventricular pressure looks the same. atrial pressure still increased in the same fashion, as in acute but to a lesser decree (compliant LA)

Question 9

how does MR beget more MR aka what is the problem with chronic MR?

Answer 9

increase in LV volume = decrease in LV systolic functions (bad genes). also can stretch the annulus so even more MR

Question 10

chronic MR: as LV function decreases what happens?

Answer 10

decompensation, less forward output = fatigue. also more back pressure so higher LAP and pulmonary pressure. heart failure!

Question 11

chronic MR: what LA problem can it cause

Answer 11

long standing increase in LA volume: risk of A fib, blood clots

Question 12

chronic MR: what RV problems does it cause?

Answer 12

long standing increased pulmonary venous pressures = pulmonary hypertension. leads to right ventricular failure (tries to keep up cardiac output but can’t) and dilation (can’t easily thicken so dilates) = peripheral edema and low forward output

Question 13

chronic MR: progression of disease?

Answer 13

long asymptomatic time course, with a gradual and insidious onsent of symptoms

Question 14

chronic MR: what are the symptoms of increased backward pressure

Answer 14

same as in left heart failure (and mitral stenosis): SOB, orthopnea, SND

Question 15

later symptoms of chronic MR

Answer 15

long standing LA back pressure: A fib. right heart failure (peripheral edema, ascites, also low RV forward output so fatigue and weakness but less dyspnea)

Question 16

physical exam in chronic MR: BP? HR? lungs?

Answer 16

all normal, lungs clear

Question 17

physical exam in chronic MR: apex? what else can you feel?

Answer 17

LV apex enlarged, diffuse, displaced, hyperdynamic. can feel a palpable MR thrill

Question 18

physical exam in chronic MR: heart sounds

Answer 18

S1 variable, S2 early. S3 from LV volume load. pansystolic murmur from turbulent MR flow. diastolic murmur from torrential flow across MV in diastole.

Question 19

describe the systolic murmur in MR

Answer 19

pan systolic and holosystolic, since the gradient from LV to LA persists throughout systole. high pitched.

Question 20

pan systolic murmur in MR is loudest where? radiation? intensity?

Answer 20

loudest at mitral area/apex. radiates widely, but usually into axilla. tends to remain same intensity even if HR changes (b/c of the huge pressure gradient)