Mitral Stenosis Flashcards
What is the Mitral Valve Annulus?
Anatomic junction between LA and LV
LA: Left Atrium, LV: Left Ventricle
Describe the basic shape of the Mitral Valve Annulus.
Basically D-shaped, with a straight section representing the aortomitral curtain
What type of continuity exists between the aortic valve annulus and the anterior MV leaflet?
Fibrous continuity
How does the three-dimensional shape of the Mitral Valve Annulus appear?
More complex and appears more like a ‘saddle’
What passes through the medial trigone?
AV conduction system
What is the most common cause of inflammatory etiology in valvular heart disease?
Rheumatic fever
Rheumatic fever is a significant cause of heart valve issues, particularly in younger populations.
What are the degenerative causes of valvular heart disease?
Calcification (elderly)
Calcification of heart valves is often seen in older adults, leading to stenosis or regurgitation.
Name a structural cause of valvular heart disease associated with carcinoid.
Thickened/restricted leaflets
Carcinoid syndrome can lead to fibrous and thickened heart valves, particularly affecting the right side of the heart.
What type of tumor can cause left atrial obstruction in valvular heart disease?
Myxoma
A myxoma is a benign tumor that can obstruct blood flow and mimic mitral stenosis.
What is a genetic condition associated with structural heart defects leading to valvular issues?
Congenital Heart Disease (CHD)
Conditions like parachute mitral valve or double orifice mitral valve are examples of congenital heart defects.
Fill in the blank: _______ is a rare congenital heart disease characterized by supravalvular membrane.
Shone’s syndrome
Shone’s syndrome involves multiple left heart obstructive lesions, including a supravalvular membrane.
What is the term for a mitral valve with all chordae attached to one papillary muscle?
Parachute mitral valve
This anomaly can lead to significant mitral regurgitation due to abnormal leaflet motion.
What is the principal symptom associated with high LAP/PCWP/PHTN?
Dyspnea at rest or on exertion (DOE)
Dyspnea is a common symptom in various cardiac conditions, indicating difficulty in breathing.
What is hemoptysis?
Bloody sputum due to high pressure in lung
Hemoptysis is often a sign of underlying pulmonary or cardiac issues.
What causes fatigue in patients with high LAP/PCWP/PHTN?
Low cardiac output (CO)
Fatigue can indicate inadequate perfusion of tissues due to reduced heart efficiency.
What symptom is associated with arrhythmia due to LAE/high pressure?
Palpitations
Palpitations may occur when the heart experiences irregular rhythms, often due to structural changes.
What is syncope and how is it related to cardiac conditions?
Loss of consciousness due to low cardiac output
Syncope can result from inadequate blood flow to the brain, often linked to heart dysfunction.
What is a late finding in high LAP/PCWP/PHTN that indicates right heart failure?
Right heart failure
Right heart failure can occur as a result of prolonged pressure overload in the pulmonary circulation.
What arrhythmia may present due to a big left atrium and high pressure?
Atrial fibrillation (AFib)
Atrial fibrillation can occur due to structural changes in the heart, particularly in the atria.
What is a murmur in cardiac auscultation?
Low-pitched diastolic ‘rumble’ at the apex
Murmurs can indicate various cardiac conditions and are assessed for timing, pitch, and quality.
What is the significance of the opening ‘snap’ sound in cardiac auscultation?
Correlates with the forceful opening of the mitral valve (MV)
The opening snap is an important physical sign in diagnosing mitral stenosis.
What does a loud S1 indicate in cardiac auscultation?
Increased force to close the valve
A loud S1 may suggest conditions such as hyperdynamic circulation or mitral valve closure abnormalities.
What is the purpose of prophylactic antibiotics in medical treatment?
To avoid recurrence of RF
RF refers to rheumatic fever.
Name two antiarrhythmic medications used in medical treatment.
- Digitalis
- Amiodarone
What is the role of beta blockers in medical treatment?
Slows HR, improves filling
What do diuretics do in medical treatment?
Rids the body of excess fluid
Why is activity restriction recommended in medical treatment?
To avoid DOE and acute CHF
What is cardioversion used for?
For AFib only
What is the purpose of the Maze procedure?
For AFib-atrial remapping only
What is balloon valvuloplasty?
Cracking the valve open
What is commissurotomy?
Cracking the valve open
What are the options for mitral valve replacement?
- Mechanical
- Bio
What is Rheumatic Valve Disease?
Occurs secondary to episode(s) of acute rheumatic fever (ARF)
Rheumatic Valve Disease is a condition that develops as a complication of ARF.
What type of response causes damage to the mitral valve apparatus in Rheumatic Valve Disease?
Autoimmune response several years after ARF
This autoimmune response leads to chronic damage to the heart valves.
What does MS stand for in the context of Rheumatic Valve Disease?
Mitral Stenosis
MS refers to the narrowing of the mitral valve opening.
What are the key structural changes that occur in the mitral valve due to MS?
Thickening/fibrosis of MVLs, commissural fusion & shortening/matting of tendinous cords
MVLs stands for mitral valve leaflets.
What is the characteristic shape of the mitral valve orifice in MS?
“fish mouth” MV orifice
This term describes the appearance of the narrowed valve opening.
What is a common complication associated with the leaflets and cords in Rheumatic Valve Disease?
Calcification of commissures, leaflets and cords
Calcification contributes to the stiffness and dysfunction of the valve.
What is the appearance of the anterior mitral valve (MV) leaflet in rheumatic mitral stenosis?
Doming ‘Hockey Stick’ Appearance
This appearance is characterized by a distinct shape resembling a hockey stick due to the leaflet’s deformation.
What are the characteristics of the leaflets in rheumatic mitral stenosis?
Thickened leaflets, especially at the tips
This thickening contributes to the obstruction of blood flow through the mitral valve.
True or False: In rheumatic mitral stenosis, the anterior mitral valve leaflet typically appears thin and flexible.
False
The anterior mitral valve leaflet is thickened in rheumatic mitral stenosis.
Fill in the blank: The anterior mitral valve leaflet in rheumatic mitral stenosis has a _______ appearance.
Doming ‘Hockey Stick’
This specific appearance is a key diagnostic feature in imaging studies.
What are the M-Mode findings in MS?
Thickened, restricted leaflets
Refers to the abnormal appearance of the mitral valve leaflets in mitral stenosis.
What is the significance of the decreased ‘E-F’ slope in M-Mode findings?
Indicates doming of the anterior mitral valve leaflet
The ‘E-F’ slope is a measurement related to diastolic function and can indicate mitral valve abnormalities.
Fill in the blank: The M-Mode finding of thickened, restricted leaflets is associated with _______.
[mitral stenosis]
True or False: Decreased ‘E-F’ slope is a sign of improved diastolic function.
False
A decreased ‘E-F’ slope suggests impaired diastolic function due to mitral valve abnormalities.
What is the primary degenerative process in Extensive MAC?
Usually affecting posterior annulus > anterior
Which conditions are frequently associated with Extensive MAC?
- FED
- Barlow’s
- Marfan’s
- Diabetes
- Renal dialysis patients
What does MS result from in the context of Extensive MAC?
Extension of MAC onto leaflets, reducing mobility
Are leaflet tips affected by calcium deposits in Extensive MAC?
Leaflet tips are usually spared from calcium deposits
Is there commissural fusion in Extensive MAC?
NO commissural fusion, as with rheumatic disease
What is MAC
Mitral Annulus Calcification
What is Cor Triatriatum?
A rare congenital heart defect characterized by a membrane across the left atrium
What does Cor Triatriatum mimic?
It mimics mitral stenosis (MS)
True or False: Cor Triatriatum is a common congenital heart defect.
False
Cor Triatriatum creates obstruction in which part of the heart?
Left atrium
Fill in the blank: Cor Triatriatum is a rare condition that involves a membrane across the _______.
left atrium
2D planimetry values for mitral stenosis
• Normal > 4 cm2
• Mild MS > 1.5 cm2
• Moderate 1-1.5 cm2
• Severe < 1 cm2
MVA equation
MVA = 220/p1/2t
