Mitral Regurgitation Flashcards
name the 4 vital parts of mitral valve fn
The leaflets, the chordae, annulus, and papillary muscle
Define Primary and secondary mitral regurg
Primary: problem with leaflets/papillary muscle. Secondary: LV enlargement
Primary Problems with the leaflets
Reduced mobility, normal mobility but not closing, increased mobility
What causes reduced leaflet mobility
Scarring post-rheumatic fever
What causes normal leaflet mobility mitral regurg?
Hole in valve, usually from infection/endocarditis
What causes increased leaflet mobility mitral regurg?
Prolapsed leaflet (too far back), or flail leaflet (chord is cut)
Cause of and Tx for MV prolapse
Softer tissue. Usually benign, can cause severe MR if chords stretch. May cause click when MV stiffens. If Tx needed, repair or replace.
Causes of secondary leaflet problems
Papillary muscle doesn’t pull enough, Scarred (ischemic) papillary m. pulls it open too much, or LV dilation pulls annulus open
Consequences of Mitral regurg on heart
LV pumps into LA (stretch) and LV has to stretch (“old and new” blood to accommodate)
What happens in acute mitral regurg?
Sudden stretch of LA, pulm. edema plus low flow forward = cardiogenic shock. Higher HR, lower BP.
Heart sounds on acute mitral regurg?
S3 and S4 (early and late LV filling), systolic murmur (LV to LA)
Talk about chronic mitral regurg
Time to expand LA and LV, no pulm edema right away.
What would worsen MR in chronic MR?
Hypertension or aortic stenosis
Complications of chronic MR
Increasing LV size eventually pulls open MV, output goes down and backflow goes up( LA stretch (risk of a fib), pulm. edema)
Symptoms and signs of chronic MR
Fatigue, weakness, a fib, Heart failure, large apex, thrills possible, S3, pansystolic and diastolic murmur. Murmurs don’t change with heart intensity (unlike AS)
