mitral stenosis and regurg Flashcards
normal mitral valve area
3-5 cm2
Mitral stenosis is almost always due to
Rheumatic causes - GAS
Aschoff nodules on histology are class for
mitral stenosis
normal pulmonary capillary wedge pressure is
6-12 mmHg
left atrial dilatation can result in
stasis - thromboembolism
risk for A fib
what does increased left atrial pressures lead to
pulmonary congestion - dyspnea
what is the mean gradient that results in symptoms with minimal activity in MS
> 10 mmHg
when does the opening snap occur in MS
right after S2, higher gradient, sooner the snap
diastolic rumble with a presystolic accentuation, and an opening snap is classic for
mitral stenosis
what are the ECG findings in mitral stenosis
rhythm is irregularly irregular
No P waves - A fib!
A fibrillation is a common result of
mitral stenosis
Features on CXR indicative of mitral stenosis
- splayed carina
- straight left heart border -
- pulmonary venous congestion
how do you treat mitral stenosis
- diuretic -
- treat A fib - amiodarone
- prevent embolism - coumadin
- treat endocarditis
If you are class 3 or 4, with valve area
definitely treat Mitral stenosis
Severe mitral stenosis
very Probably should treat
If your valve area is less than 1.5 with new onset A fib
probably you should treat
when is mitral regurgitation very serious
when you have reduced ejection fraction!!
Features of acute mitral regurg
- decreased afterload but increased preload
- increased contracility
- decreased forward output -
- pulmonary edema, shock
in chronic mitral regurg
LA dilates and pressures in it return to normal but prone to A fib
pansystolic murmur - high gradient high pitch
- apex is dilated and displaced, S3 and may feel a thrill
- mitral regurg
how can you treat mitral regurg
- reduce afterload - acei
- reduce preload with diuretic
who should get surgery for mitral regurg
- acute and symptomatic MR
- symptoms and good ventricle
- symptoms or not with falling ejection fraction
when is surgery contraindicated for mitral reurg
those with severe ventricular dysfunction
endocarditis prophylaxis 3 conditions
- previous endocarditis
- prosthetic heart valve
- unrepaired congenital heart disease
