mitral stenosis and regurg

Question 1

what is etiology for mitral stenosis

Answer 1

• almost always rheumatic

- murmur appears 20 years later

Question 2

what happens in rheumatic

Answer 2

• fibrotic rigid mitral leaflets
• fused valvular commissures
• thick short fused chordae
• calcification of leaflets

Question 3

what is patho in mitral stenosis

Answer 3

• L atrial Pressure
• pulm HT and interstitial/alveolar pulm edema due to back transmission
• large atrium = thrombus risk, Afib risk

Question 4

what is use of cath

Answer 4

normal Pulm wedge pressure = 6-12mmHg
> 25 causes transudation
- incr. pulm venous and cap pressure

Question 5

what happen on Left heart

Answer 5

• reduced mitral inflow

- low output

Question 6

4 possible complications

Answer 6

1. pulm edema and hemoptysis
2. A fib and cardioembolism
3. R heart failure
4. endocarditis

Question 7

** what is murmur in mitral stenosis

Answer 7

opening snap and decrescendo in diastole

Question 8

what might be seen on ECG

Answer 8

• afib

- R vent hypertrophy with strain pattern

Question 9

what is seen in CXR

Answer 9

• splayed carina
• straight left heart border
• pulm venous congestion

Question 10

4 possible medical therapies

Answer 10

1. reduce pulm edema
   - diuetics
2. prevent/treat afib
   - antiarrhtymics
3. prevent embolism
   - anticoag
4. prevent Tx endocard
   - oral hygene
   - early recog and Tx

Question 11

3 indications for intervention

Answer 11

definite
- NYHA 3-4 and valve60-80
prob
- Asx with moderate or worse stenosis

Question 12

what is intervention

Answer 12

valve replacement

Question 13

3 parts of mitral regurg etiology

Answer 13

1. leaflet chordae
   - endo, rhuem, congenital
2. annulus
   - LV dilatation
3. papillary muscles
   - iscehmia or infart

Question 14

what is pathphys in chronic

Answer 14

• 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

Question 15

what is patho in acute

Answer 15

• sudden vol overload
• LV and LA not ready
• high preload, low afterload
• high contractility
• poor outflow - pulm edema and shock

Question 16

Sx of regurg

Answer 16

• fatiuge
• exertional dyspnea
• orthopnea
• edema
• PND
• palpitation

Question 17

4 parts of workup

Answer 17

1. ECG
   - LA enlarged, LV hypertrophy
2. CXR
   - megaly, atrial dilatation
3. ECHO
4. cath

Question 18

5 parts of medical ther

Answer 18

1. TX underlying cause if possible
2. aftreload reduction - ACEi
3. preload reduction - diuretics
4. endo recog and Tx
5. antiarryhtmi and anticoag

Question 19

indications for surge

Answer 19

definint
- acute Sx
- NYHA 2-4 and normal vent function
Contraindicated in severe vent dysfunction

Question 20

what is patho of endo

Answer 20

exposure (bacteremia) + diathesis (preexisting lesion)

Question 21

2 main types of phenommena seen with it

Answer 21

1. vasc
2. iummunological
   - glomeruloneph
   - RF +ve
   - osler nodes

Question 22

*** duke criteria for endo

Answer 22

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

Question 23

3 Tx of endo

Answer 23

1. targeted ABx
2. elim portal of entry
3. valve surgery

Question 24

3 groups to prophylax

Answer 24

1. prosthetic heart valves
2. previous endo
3. unrepaired complex congential heart disease

Question 25

4 common errors in endo

Answer 25

1. failure to recog. asymptomatic LV dys in mitral regurg
2. failure to anti-coag in Afib
3. failure to provide bridging anti-coag for vavlular prostheses
4. failure to recognize and Tx endo

Question 26

3 groups not ti echo from choosing wisely

Answer 26

1. asymtomatic PT with innocent murmurs
2. asymptomatic PT with mild stenosis more than 3-5 years
3. asymptomatic PT with mild mitral regurg and normal LV function