Mitral Regurgitation

Question 1

What is Mitral Regurgitation (MR)?

Answer 1

Retrograde flow into the LA through the closed MV during systole, while valve is supposed to be closed

Question 2

MR Clues often seen where?

Answer 2

2D echo & Color Flow

Question 3

What is the MR murmur?

Answer 3

Holosystolic murmur that radiates to the axilla, high pitched blowing

Question 4

What are causes of MR?

Answer 4

Rheumatic Fever, Annulus dilation, MAC, MVP, MS, Flail Leaflets, Vegetations, Chordae rupture, pap rupture, Congenital, LVE

Question 5

What are complications of MR?

Answer 5

Volume overload in LA, leading to LAE and increased LAP, LVVO pattern due to increased preload(volume in the LV during end diastole) which leads to LV dilation, leading to LV hypertrophy, long standing MR leads to PHTN

Question 6

Symptoms of MR?

Answer 6

Often none, Fatigue, DOE papitations, CP, CHF

Question 7

What happens with MR?

Answer 7

Normally SV is 70-100cc ejected each beat, but with MR, SV increased LV + MR in LA&raquo_space; LV volume overload (LVVO) over time

Question 8

What is Preload?

Answer 8

Amount of diastolic filling of the ventricles

Question 9

How does increased preload affect conditions of the heart?

Answer 9

Increases cardiac performance to a point, Frank-Starling Law

Question 10

How does increased preload affect physiologic response of the heart?

Answer 10

Hyperdynamic, Contracts stronger, stronger squeeze at that moment

Question 11

Preload & MR

Answer 11

LVVO pattern, Chamber dilation (LA-LV) & hypercontractility to maintain CO

Question 12

Frank - Starling Law? or Length - Tension

Answer 12

The greater the stretch of the cardiac muscle cell(length or preload), the greater the force of the contraction(tension), to a limit, then contractility begins to fail

Question 13

2D Echo signs for MR?

Answer 13

Defect of the MV that inhibits closure valve, LAE, LVVO, LVE, LV hypertrophy, RVE

Question 14

M-Mode findings for MR?

Answer 14

hypercontractile motion , LVE, LVVO, AOV notching mid-systolic closure, LAE, PHTN,

Question 15

Chronic MR leads to what?

Answer 15

LAE, LVE, increased LAP leads to PHTN, which leads to LV no longer compensating and muscle fails = decompensation

Question 16

Acute MR result of?

Answer 16

MI or IHD/CAD, pap rupture or dysfunction, PHTN

Question 17

MR color flow used for?

Answer 17

Semi-quantitative, time saver, shape and direction, increases accuracy of spectral doppler

Question 18

Grades of MR?

Answer 18

• Grade I - Mild - 1+ - < 20% LA, jet extends just beyond MV leaflets
• Grade II - Moderate - 2+ - 20-40% LA, jet extends 1/3 into LA
• Grade III - Moderate - Severe - 3+ - > 40% LA, jet extends into 1/2 into LA
• Grade IV - Severe - 4+ - jet extends to back of LA, into pulm veins

Question 19

RJA?

Answer 19

Regurgitant Jet Area: Trace MR in PLAX, PSAX, Ap 4, Mild 8cm squared

Question 20

RJA/LAA?

Answer 20

Method of using trace of MR jet & trace of LAA to get ratio of jet to LA size, Mild < 20%, Severe > 40% (usually visually estimated)

Question 21

What is the Vena Contracta?

Answer 21

Uses CF to estimate width(diameter) of

narrowest opening the regurgitant flow passes through, larger = more severe, mild < 0.3cm, severe > 0.7 cm, PLAX, Ap 4

Question 22

What is PISA?

Answer 22

Proximal Isovelocity Surface Area - uses CF to identify flow convergence region, which is the golf ball area of flow for example in MR in the LV (proximal to MV)

Question 23

MR CW Doppler evaluation?

Answer 23

Uniform signal strength, well defined signal, increased mitral flow velocity = more severe

Question 24

What is MVP?

Answer 24

Mitral Valve Prolapse, Leaflet bowing back beyond plane of MV annulus by > 3mm

Question 25

What are other names MVP known by?

Answer 25

Myxomatous MV disease, Barlow’s Syndrome, Floppy valve, systolic click
murmur

Question 26

Causes of MVP?

Answer 26

Myxomatous degenerative of MV= thickened leaflets, congenital, hereditary = Marfans

Question 27

What is murmur for MVP?

Answer 27

Mid-late systolic click, w/wout murmur

Question 28

What are symptoms of MVP?

Answer 28

Most are asymptomatic, may have fatigue, dyspnea, CP, arrhythmias, dizziness, syncope, ruptured chordae, increased risk
of bacterial endocarditis

Question 29

Myxomatous Leaflets?

Answer 29

Thick and echogenic, no shadow

Question 30

Calclified Leaflets?

Answer 30

More spotty look and shadowing will occur below leaflets

Question 31

What are findings of MVP on M-mode?

Answer 31

Mid-late systolic buckling of leaflets, holosystolic hammocking

Question 32

What are findings of MVP with CF?

Answer 32

Prolapsing PMVL has an anteriorly directed jet while the prolapsing AMVL has a posteriorly directed jet

Question 33

What is a parachute MV?

Answer 33

only one pap muscle connecting both leaflets

Question 34

Significant MV regurg indicated how?

Answer 34

Increased MV E velocity (greater than 1.2 m/a