Mitral Regurgitation 3 Flashcards
decompensated MR: physical findings for BP? HR? lungs?
BP may be decreased. might have A fib. decreased edema (so less crackling) b/c RV having trouble delivering blood
decompensated MR physical: what can you feel? why?
recall that decompensated MR: right heart failure now. RV heave (also see elevated JVP) because of the RV enlargement
decompensated MR: what will you hear?
loud S2 (pulmonary). RV S3 from the RV volume load. also a parasternal pansystolic murmur from leaky tricupsid valve.
ECG findings in MR
might see: LVH, LA enlargement., A fib
CXR findings for MR
enlarged LV, LA. prominent pulmonary veins. if decompensated, then large RV and pulmonary edema
test of choice to assess MR
echocardiogram: define leaflet, chord, annulus morphology. assess MR severity. also look at chamber sizes and functions
MR prevention (4)
no antibiotics necessary before dental work. maintain good dental hygiene. careful followup of asymptomatic pts. regular echo exams to assess LV size/function
MR: medical treatments
blood pressure drugs. diuretics/nitrates. rate slowing drugs. anti-arrhythmics
why give BP drugs in MR? when is it or isn’t it useful?
lower BP = lower LV pressure = lower MR. useful for acute MR, not really useful in chronic unless you’re hypertensive
why give diuretics/nitrates in MR?
alleviate HF symptoms from volume overload
why give rate slowing drugs/anti arrhythmics in MR?
prevent excessive tachycardia, you’re worried about A fib. also give coumadin.
timing of MR surgery?
optimal timing of surgery difficult b/c insidious course, and MR offloads the LV so it makes the dysfunction on tests
best predictor of post op outcome? how to measure?
LV dysfunction: predicts poor outcome –> markers of LV dysfunction = ejection fraction, end systolic volume
MR: you should follow patients with
routine echo
MR surgery: when to have?
once significant symptoms (HF, edema) develop. or in asymptomatic pts, when there is progressive LV dilation or dysfunction
