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CV exam 1 wk 2 > mitral/tricuspid 2 > Flashcards

mitral/tricuspid 2 Flashcards

1
Q

Mitral valve replacement

A
  1. bioprosthetic valves

2. mechanical valves

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2
Q

Mitral valve tx:

A
  1. medication
  2. valve replacement
  3. percutaneous balloon mitral vavuloplasty
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3
Q

MS: indications for tx:

A
  1. symptoms
  2. A fib
  3. pulmonary hypertension
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4
Q

MS: key points

A
  1. most common cause rhyematic MV disease
  2. clincial presentation: CHF, R sided HF, A fib, stroke
  3. Physical: loud S2, opening snap, diastolic rumble
  4. tx drug: b blocker, diuretic, anti-coag
  5. intervention: balloon valvulplasty vs. valve replacement
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5
Q

mitral regurgitation

A

inadequate mitral valve closure that blood flows back from LV to LA, during systole

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6
Q

mitral regurgitation may be caused by

A

abnormality of any component of MV apparatus

  1. annulus
  2. leaflets
  3. chordae
  4. papillary muscles
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7
Q

mitral regurgitation etiology

A
  1. Myxomatous degeneration: mitral valve prolapse
  2. Ischemic heart disease: papillary muscle dysfunction or rupture
  3. Endocarditis: valve deformity, perforation
  4. Rheumatic valve disease
  5. LV enlargement: stretches mitral annulus and/or papillary muscles
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8
Q

Mitral regurgitation: Physical exam

A

holosystolic murmur best heart at the apex with radiation to the axilla

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9
Q

mitral valve prolapse: physical exam

A

Midsystolic click die to the sudden tensing of the chordae tendinaea and mitral leaflet, followed by a late systolic murmur

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10
Q

mitral valve prolapse

A
  1. most often asymptomatic and found on routine physical exam
  2. clinical course is typically benign with good prognosis
  3. the primary concern is the development of progressive mitral regurgitation over time
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11
Q

mitral regurgitation: hemodynamics

A
  1. part of the LV SV is ejected backwards in the LA
  2. Elevated LA volume and Pressure cause Pulmonary edema, pulmonary hypertension
  3. Decreased forward CO
  4. Volume related stress on the LV (the regurgitated blood returns to the LV along with normal pulmonary Blood volume)
    this may lead to LV dysfunction over time
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12
Q

Mitral regurgitation: clincial presentation

A

CHF

  1. dyspnea on exertion
  2. orthopnea
  3. paroxysmal nocturnal dysnpnea
  4. Edema
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13
Q

mitral regurgitation: Tx

A
  1. medication
  2. surgery
  3. mitraclip
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14
Q

Mitral regurgitation medication

A
  1. diuretic for CHF

2. afterload reduction (ACE inhibitors or ARBs)

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15
Q

mitral regurgitation surger

A
  1. mitral valve repair (preferred)
  2. mitral valve replacement

bioprosthetic vs mechanical

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16
Q

mitral regurgitation: surgical indication for chronic severe MR

A
  1. symptoms
  2. LV dilation
  3. decreased LV systolic function
  4. New onset Atrial fibrialltion
  5. pulmonary hypertension
17
Q

____ most common cause of primary MR

A

mitral valve prolapse

18
Q

secondary MR most commonly occurs in pt with

A

severe LV dysfunction and dilation

19
Q

MR: physical exam

A

holosystolic murmur at the apex radiating to the axilla

20
Q

MR: treatment

A
  1. medications: diuretics, afterload reduction
  2. Surgery: MV repair is preferred over MV replacement due
    to lower operative mortality and better long term outcomes
21
Q

tricuspid valve functions

A
  1. opens in diastole to allow blood to flow from the RA to the RV
  2. closes in systole to prevent blood in the RV from flowing backwards into the RA
22
Q

Tricuspid regurgitation occurs during

A

systole, the tricuspid valve does not close adequately and blood flows backwards into the RA

23
Q

Tricuspid regurgitation results in

A
  1. elevated RA pressure leads to increased venous pressure

2. LE edema, ascites, hepatic congestion

24
Q

causes of tricuspid regurgitation:

A
  1. structural abnormality of TV
  2. acquired
  3. Functional (morphologically normal leaflets with annular dilation)
25
Q

tricuspid regurgitation: Structural abnormality of the TV

A
  1. Congenital
  2. Ebstein anomaly
  3. TV dysplasia
  4. TV hypoplasia
  5. TV cleft
  6. Double-orifice TV
  7. Unguarded TV orifice
26
Q

tricuspid regurgitation: acquired

A
  1. Endocarditis
  2. Trauma
  3. Carcinoid heart disease
  4. Rheumatic heart disease
  5. TV prolapse
  6. Iatrogenic (radiation, drugs, biopsy, device lead)
27
Q

tricuspid regurgitation: Functional

A
  1. Idiopathic tricuspid annular dilatation
  2. RV dysplasia
  3. Endomyocardial fibrosis
  4. Primary PHT
  5. Secondary PHT
  6. Atrial septal defect
  7. Anomalous pulmonary venous drainage
28
Q

Tricuspid Regurgiation: Etiology

A
  1. 80% of cases of significant TR are functional
    – Secondary to annular dilation and leaflet tethering in the setting of RV dilation from volume and/or pressure overload
  2. Other causes include:
    – Rheumatic disease, congenital disease (Ebstein’s), endocarditis, radiation, carcinoid, trauma from endomyocardial biopsy, pacemaker leads

CV exam 1 wk 2 (35 decks)

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