Mitral Regurgitation

Question 1

name the 4 vital parts of mitral valve fn

Answer 1

The leaflets, the chordae, annulus, and papillary muscle

Question 2

Define Primary and secondary mitral regurg

Answer 2

Primary: problem with leaflets/papillary muscle. Secondary: LV enlargement

Question 3

Primary Problems with the leaflets

Answer 3

Reduced mobility, normal mobility but not closing, increased mobility

Question 4

What causes reduced leaflet mobility

Answer 4

Scarring post-rheumatic fever

Question 5

What causes normal leaflet mobility mitral regurg?

Answer 5

Hole in valve, usually from infection/endocarditis

Question 6

What causes increased leaflet mobility mitral regurg?

Answer 6

Prolapsed leaflet (too far back), or flail leaflet (chord is cut)

Question 7

Cause of and Tx for MV prolapse

Answer 7

Softer tissue. Usually benign, can cause severe MR if chords stretch. May cause click when MV stiffens. If Tx needed, repair or replace.

Question 8

Causes of secondary leaflet problems

Answer 8

Papillary muscle doesn’t pull enough, Scarred (ischemic) papillary m. pulls it open too much, or LV dilation pulls annulus open

Question 9

Consequences of Mitral regurg on heart

Answer 9

LV pumps into LA (stretch) and LV has to stretch (“old and new” blood to accommodate)

Question 10

What happens in acute mitral regurg?

Answer 10

Sudden stretch of LA, pulm. edema plus low flow forward = cardiogenic shock. Higher HR, lower BP.

Question 11

Heart sounds on acute mitral regurg?

Answer 11

S3 and S4 (early and late LV filling), systolic murmur (LV to LA)

Question 12

Talk about chronic mitral regurg

Answer 12

Time to expand LA and LV, no pulm edema right away.

Question 13

What would worsen MR in chronic MR?

Answer 13

Hypertension or aortic stenosis

Question 14

Complications of chronic MR

Answer 14

Increasing LV size eventually pulls open MV, output goes down and backflow goes up( LA stretch (risk of a fib), pulm. edema)

Question 15

Symptoms and signs of chronic MR

Answer 15

Fatigue, weakness, a fib, Heart failure, large apex, thrills possible, S3, pansystolic and diastolic murmur. Murmurs don’t change with heart intensity (unlike AS)

Question 16

Compare chronic and acute mitral regurg

Answer 16

Acute: non-dlated, non-compliant, high HR, decresc. S4, low output. Chronic: dilated and compliant, parasternal heave, S3 + pansystolic murmur, heart failure

Question 17

Mitral Regurg tests and results

Answer 17

ECG: maybe enlargement; CXR: large, pulm. edema; Echo is best: see in action, size; cardiac cath.: check coronaries

Question 18

Preventing complications of diagnosed MR

Answer 18

Good oral health, followup, regular echos.

Question 19

Tx for mitral regurg

Answer 19

Lower BP: only helpful in acute MR. Tx for heart failure symptoms. Rate-slowing drugs for A fib (plus coumadin)

Question 20

Indications for surgery for MR

Answer 20

Want to catch symptoms early for best outcome. Necessary if HF starts or if LV is dilating. LV can bounce back if caught early enough