mitral stenosis and regurg Flashcards
what is etiology for mitral stenosis
- almost always rheumatic
- murmur appears 20 years later
what happens in rheumatic
- fibrotic rigid mitral leaflets
- fused valvular commissures
- thick short fused chordae
- calcification of leaflets
what is patho in mitral stenosis
- L atrial Pressure
- pulm HT and interstitial/alveolar pulm edema due to back transmission
- large atrium = thrombus risk, Afib risk
what is use of cath
normal Pulm wedge pressure = 6-12mmHg
> 25 causes transudation
- incr. pulm venous and cap pressure
what happen on Left heart
- reduced mitral inflow
- low output
4 possible complications
- pulm edema and hemoptysis
- A fib and cardioembolism
- R heart failure
- endocarditis
** what is murmur in mitral stenosis
opening snap and decrescendo in diastole
what might be seen on ECG
- afib
- R vent hypertrophy with strain pattern
what is seen in CXR
- splayed carina
- straight left heart border
- pulm venous congestion
4 possible medical therapies
- reduce pulm edema
- diuetics - prevent/treat afib
- antiarrhtymics - prevent embolism
- anticoag - prevent Tx endocard
- oral hygene
- early recog and Tx
3 indications for intervention
definite
- NYHA 3-4 and valve60-80
prob
- Asx with moderate or worse stenosis
what is intervention
valve replacement
3 parts of mitral regurg etiology
- leaflet chordae
- endo, rhuem, congenital - annulus
- LV dilatation - papillary muscles
- iscehmia or infart
what is pathphys in chronic
- state of LV and LA vol ume overload
- systolic function may remain normal or years until fibrosis
- low P LA outlet may mask clinical deterioration
- may have intact EF - reduced EF is bad sign
what is patho in acute
- sudden vol overload
- LV and LA not ready
- high preload, low afterload
- high contractility
- poor outflow - pulm edema and shock
Sx of regurg
- fatiuge
- exertional dyspnea
- orthopnea
- edema
- PND
- palpitation
4 parts of workup
- ECG
- LA enlarged, LV hypertrophy - CXR
- megaly, atrial dilatation - ECHO
- cath
5 parts of medical ther
- TX underlying cause if possible
- aftreload reduction - ACEi
- preload reduction - diuretics
- endo recog and Tx
- antiarryhtmi and anticoag
indications for surge
definint
- acute Sx
- NYHA 2-4 and normal vent function
Contraindicated in severe vent dysfunction
what is patho of endo
exposure (bacteremia) + diathesis (preexisting lesion)
2 main types of phenommena seen with it
- vasc
- iummunological
- glomeruloneph
- RF +ve
- osler nodes
*** duke criteria for endo
2 major, or 1 major 3 minor, or 5 minor MAJOR -blood culture with typical organisms - evidence of endocardial involvment MINOR - predisposition - fever - vasc. phenom - immuno phenom - microbiol evidence
3 Tx of endo
- targeted ABx
- elim portal of entry
- valve surgery
3 groups to prophylax
- prosthetic heart valves
- previous endo
- unrepaired complex congential heart disease
4 common errors in endo
- failure to recog. asymptomatic LV dys in mitral regurg
- failure to anti-coag in Afib
- failure to provide bridging anti-coag for vavlular prostheses
- failure to recognize and Tx endo
3 groups not ti echo from choosing wisely
- asymtomatic PT with innocent murmurs
- asymptomatic PT with mild stenosis more than 3-5 years
- asymptomatic PT with mild mitral regurg and normal LV function
