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Fall Cardiac Theory > Mitral Stenosis > Flashcards

Mitral Stenosis Flashcards

1
Q

What is the number one cause of MS?

A

rheumatic

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2
Q

What causes Mitral Stenosis?

A
  1. Rheumatic
  2. Severe mitral annulus Ca+ deposition
  3. Left Atrial Myxoma
  4. Congenital
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3
Q

Rheumatic is most common in?

A

women ages 30-50 and when pregnant due to increase volume flow

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4
Q

What is Left Atrial Myxoma?

A

benign tumor that can grow in LA and cause functional stenosis. Typically attached to IAS

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5
Q

How does Congenital MS appear?

A

Parachute MV where leaflets are tethered together

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6
Q

What are the symptoms/signs of MS?

A
  1. overload to pulmonary vasculature ( DOE, hemoptysis, PND, orthopenea)
  2. inadequate cardiac output (chest pain, fatigue, syncope)
  3. overload to right side and cava
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7
Q

What is the #1 symptom of MS?

A

DOE/dyspnea

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8
Q

What is the 2nd common symptom of MS?

A

hemoptysis (sputum)

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9
Q

Name the symptoms of overload to pulmonary vasculature

A
  • DOE
  • cough
  • sputum
  • rale/cackles
  • PND
  • orthopnea
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10
Q

What does it mean when there’s an overload to pulmonary vasculature?

A

LA is pressure and volume overloaded which moves back to pulmonary veins into pulmonary vasculature

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11
Q

What are the M MODE findings of MS?

A

1.Thickened leaflets and apparatus
2. Decreased E-F slope, a wave, D-E & increased EPSS
3. Early diastolic notch on IVS
4. Anterior motion of posterior leaflet during opening (parallel motion)
5. LAE

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12
Q

What are the 2D findings of MS?

A
  1. Thickened leaflets and apparatus
  2. Anterior motion of posterior leaflet during opening
  3. Hockey stick or diastolic doming of AMVL
  4. Decreased valve opening and fusion of commissures during PSAX
  5. LAE
  6. Candle flame jet in diastole (color)
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13
Q

What are OTHER findings of MS?

A
  • fusion/fibrosis of the mitral chordae in rheumatic MS
  • Coexisting valvular disease in rheumatic (MV first, AV then TV)
  • Associated MR
  • Possible A Fib
  • Possible LA thrombus found in LAA
  • Small or protected LV and AR (chambers receiving inadeq volume)
  • Signs of pulmonary hypertension
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14
Q

What is the most obvious sign of HTN?

A

RVH eventually RVE

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15
Q

Why do we see Atrial Fibrillation with MS?

A

LA stretches and disrupts the conduction system; also irritates left atrial tissue which causes A Fib

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16
Q

What Auscultations are heard with MS?

A
  1. Low pitched diastolic rumble heard at APEX
  2. Opening snap -only heard when MV is stenosed, not in a healthy heart
  3. Loud S1
17
Q

What are the treatments of MS?

A
  1. balloon or surgical commissurotomy (definitive)
  2. MV Replacement with prosthetic valve (definitive)
  3. manage pt. waiting on definitive treatment with medications
18
Q

Who would be considered candidates for balloon commissurotomy?

A

have thin, mobile leaflets with little Ca+ & little to none subchordal involvement

19
Q

Who would NOT be considered candidates for balloon commissurotomy?

A

if moderate MR

20
Q

What occurs during a balloon or surgical commissurotomy

A

Separate the fused commissures

21
Q

What kind of medications are given to patients that are waiting for definitive treatment?

A
  • To treat CHF
  • Control arrhythmia
  • Antibiotics for recurring rheumatic fever
  • Prophylactic antibiotics
  • Anticoagulants to prevent clot
22
Q

What ways do we determine MS severity?

A
  1. E-F Slope
  2. MVA via Planimetry
  3. MPG
  4. MVA via PHT
  5. MVA by Continuity Equation
  6. MVA via PISA
23
Q

What is an ABNORMAL measurement for E-F Slope?

A

LESS than 7 cm/s

24
Q

What measurement indicates severe for E-F Slope?

A

LESS than 3 cm/s

25
Q

What are the NORMS for MVA?
Normal?
Mild?
Moderate?
Severe?

A

Normal: 4.0 - 6.0 cm²
Mild: > 1.5 - 2.5 cm²
Moderate: 1.0 - 1.5 cm²
Severe: < 1.0 cm²

26
Q

What are the NORMS for MPG?

A

Mild < 5mmHg
Moderate 5- 10 mmHg
Severe > 10 mmHg

27
Q

MVA via PHT Equation?

A

MVA cm² = 220 / PHT

28
Q

MVA by Continuity Equation?

A

MVAcm² = .785 x LVOTd² x VTI lvot /
VTI mv

29
Q

MVA via PISA (proximal isovelocity surface area) EQUATION

A

MVAcm² = 6.28 x r² x pre orifice velocity /
Orifice velocity

30
Q

How do you see RV pressure/volume overload in:

2D PSAX?
M MODE?

A

-“D” shaped LV
- paradoxic septal motion

31
Q

What does paradoxic septal motion mean?

A

timing or direction of contraction is off

32
Q

Whats a LIMITATION of using MVA via PHT?

A
  • poor apical window
  • difficult in A Fib
33
Q

What is LUTEMBACHERS SYNDROME?

A

combination of atrial septal defect and mitral stenosis

  • congenital or acquired
34
Q

What happens with Lutembachers Syndrome?

A

blood flows to the RA through the ASD instread of going backward into the pulmonary veins, avoiding pulm, hypertension

Fall Cardiac Theory (18 decks)

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