Mitral Regurgitation Flashcards
Causes:
What are the main 2 causes?
How may an MI cause this?
What throat infection could cause valve disease?
All valve disease could also be caused by congenital weakness or abnormalities!
Mitral valve prolapse - causes 50%
Calcification
Papillary muscle rupture due to MI
Rheumatic heart disease
Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever.
What is the difference between rheumatic fever and rheumatic heart disease?
RF is an inflammatory disorder caused by a Group A strep throat infection.
It affects the connective tissue of the body, causing temporary, painful arthritis and other symptoms.
In some cases rheumatic fever causes long-term damage to the heart and its valves. This is called rheumatic heart disease.
Causes:
How does LV dilation and dilated cardiomyopathy both cause regurg?
Functional mitral regurgitation occurs when the left atrium or left ventricle dilates, causing the mitral valve annulus to also dilate, and thus preventing the mitral valve leaflets from coapting properly.
Mitral valve prolapse:
What is it?
Myxamatous degeneration of valve in which thickened valve leaflet is displaced into the left atrium during systole
It is a connective tissue disorder so patient may have other connective tissue disorders such as Marfan’s
S+S:
The classic triad of symptoms - mnemonic SAD
They also have some symptoms of AF. What are they?
Syncope - severe
Angina
Dyspnoea
Symptoms of AF - palpitations and an irregularly irregular HR
Signs:
- What type of murmur do you hear and where?
- Where does it radiate to?
- What else could you have at the apex?
- Where and when can you feel a thrill?
- What does S1 sound like?
What can cause acute mitral regurgitation with pulmonary oedema? - 2
- Where would you listen into for radiation?
- Do you use the diaphragm or the bell?
Pansystolic at apex
Radiates to axilla
Hyperdynamic apex beat
Systolic thrill over apex
Soft S1
Infective endocarditis
Papillary muscle rupture - MI
Into the axilla using the diaphragm
Ddx for pan systolic murmur:
Mitral regurg causes a pan-systolic murmur. What other valve can cause this? - think about the other side of the heart!
Tricuspid regurgitation - louder on inspiration
VSD - in young patients and apex displaced
Investigations:
What is diagnostic?
What could you find on ECG?
What could you see on CXR?
What further tests are available?
Echo
AF
P-mitrale if no sinus rhythm
LVH
Enlarged left ventricle and atrium - double right heart border
Valve calcification
Cardiac MRI
Angiography
Catherterisation
BNP
Management:
Medical:
- How often is it monitored?
- When is an annual echo needed?
Every 6 months
In severe disease
Management:
Surgical:
- What surgery for coronary artery disease can be done alongside mitral valve repair?
- What surgical options are there? - 3
CABG
Open repair
Valve replacements
Percutaneous repair
Complications
Structural changes - LV and LA enlargement CHF Pulmonary HTN AF Infective endocarditis
