mitral stenosis and regurg

Question 1

normal mitral valve area

Answer 1

3-5 cm2

Question 2

Mitral stenosis is almost always due to

Answer 2

Rheumatic causes - GAS

Question 3

Aschoff nodules on histology are class for

Answer 3

mitral stenosis

Question 4

normal pulmonary capillary wedge pressure is

Answer 4

6-12 mmHg

Question 5

left atrial dilatation can result in

Answer 5

stasis - thromboembolism

risk for A fib

Question 6

what does increased left atrial pressures lead to

Answer 6

pulmonary congestion - dyspnea

Question 7

what is the mean gradient that results in symptoms with minimal activity in MS

Answer 7

> 10 mmHg

Question 8

when does the opening snap occur in MS

Answer 8

right after S2, higher gradient, sooner the snap

Question 9

diastolic rumble with a presystolic accentuation, and an opening snap is classic for

Answer 9

mitral stenosis

Question 10

what are the ECG findings in mitral stenosis

Answer 10

rhythm is irregularly irregular

No P waves - A fib!

Question 11

A fibrillation is a common result of

Answer 11

mitral stenosis

Question 12

Features on CXR indicative of mitral stenosis

Answer 12

• splayed carina
• straight left heart border -
• pulmonary venous congestion

Question 13

how do you treat mitral stenosis

Answer 13

• diuretic -
• treat A fib - amiodarone
• prevent embolism - coumadin
• treat endocarditis

Question 14

If you are class 3 or 4, with valve area

Answer 14

definitely treat Mitral stenosis

Question 15

Severe mitral stenosis

Answer 15

very Probably should treat

Question 16

If your valve area is less than 1.5 with new onset A fib

Answer 16

probably you should treat

Question 17

when is mitral regurgitation very serious

Answer 17

when you have reduced ejection fraction!!

Question 18

Features of acute mitral regurg

Answer 18

• decreased afterload but increased preload
• increased contracility
• decreased forward output -
• pulmonary edema, shock

Question 19

in chronic mitral regurg

Answer 19

LA dilates and pressures in it return to normal but prone to A fib

Question 20

pansystolic murmur - high gradient high pitch

- apex is dilated and displaced, S3 and may feel a thrill

Answer 20

• mitral regurg

Question 21

how can you treat mitral regurg

Answer 21

• reduce afterload - acei

- reduce preload with diuretic

Question 22

who should get surgery for mitral regurg

Answer 22

• acute and symptomatic MR
• symptoms and good ventricle
• symptoms or not with falling ejection fraction

Question 23

when is surgery contraindicated for mitral reurg

Answer 23

those with severe ventricular dysfunction

Question 24

endocarditis prophylaxis 3 conditions

Answer 24

• previous endocarditis
• prosthetic heart valve
• unrepaired congenital heart disease