Mitral & Tricuspid valve disease Flashcards by A B

Mitral valve anatomy

1) annulus
2) leaflets
3) chordae- attach tips of leaflets to papillary muscle
4) papillary muscles- anchor leaflets to myocardium

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what does mitral valve separate?

LA and LV

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when does mitral valve open and when does it close

open in diastole

close in systole (prevent backflow)

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what happen in mitral stenosis

decr mitral valve open

obstruct flow from LA to LV

incr Pressure in LA, pulm vasculature, right heart

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most common etiology of mitral stenosis

rheumatic MS

calcific MS (old age and renal disease)

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causes of rheumatic stenosis

acute rheumatic fever (only 50%)

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what is acute rheum fever

inflammation of heart, skin, CT
by URI (group A strep)

2-3 wk after strep throat

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effect of acute rheum fever in heaeart

inflammation of valvular endocardium –> chronic rheum heart disease

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clinical effect of mitral stenosis

1) dyspnea
2) hemoptysis
3) pulm HTN
4) R sided heart failure (edema,ascites)
5) afib
6) embolic stroke

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what causes dyspnea in mitral stenosis

(incr LA pressure, incr pulm venous + capillary P –> pulm edema (fluid in pulm interstitium)

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what causes hemoptysis in mitral stenosis

incr pulm vascular pressure, rupture of bronchial vein into lung parenchyma

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what causes right sided heart failure in mitral stenosis

RV pump against high resistance from pulm HTN

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what causes afib in mitral stenosis

chronically high LA pressure –> LA dilation

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what causes emb stroke in mitral stenosis

stagnant blood flow in LA –> blood clot

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what heart sound with mitral stenosis

Listen over apex
1) loud S1 (high AV pressure gradient keeps MV open until last sec when systole closes valve)

2) opening snap after S2
3) diastolic rumble (low freq descrendo due to turbulence across stenotic valve)

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severity of MS inversely proportional to ____

interval between S2 and opening snap

high LA pressure opens valve earlier

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Mitral stenosis on ekg?

1) left atrial enlargement
2) RVH if pulm HTN present
3) afib

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Mitral stenosis on echo?

1) left atrial enlarge
2) poor open of valve during diastole
3) thick leaflet, fusion of commissure

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mitral stenosis treatment

1) beta blocker to slow HR so more time for blood to cross valve
2) diuretic to treat CHF sx
3) anticoag if afib = warfarin
4) mitral valve replacement

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types of mitral valve stenosis interventions

percutaneous balloon mitral valvuloplasty vs. valve replacement

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define percutaneous balloon mitral valvuloplasty

1) catheter into LV
2) pull balloon until against mitral valve, then expand the balloon
3) open mitral valve and relieve stenosis

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indications for intervention with mitral stenosis

1) sx
2) afib
3) pulm HTN

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mitral regurg define

inadeq mitral valve closure so blood flow back into LA during systole

causes of mitral regurg?

1) myxomatous degeneration (mitral valve prolapse)- MAIN
2) chordal rupture and LV dysfxn)
3) endocarditis (valve deform/perf)
4) rheum valve disease
5) LV enlargement (stretch mitral annulus/papillary)

mitral regurg physical exam

holocystolic murmur heard at apex and radiate to axilla

mitral valve prolapse

asymptomatic and benign concern for mitral regurg

hemodynamics of mitral regurg

1) part of LV stroke volume eject backwards 2) incr LA volume/pressure --> pulm HTN + edema 3) decr fwd CO 4) stress on LV

clinical effect of mitral regurg

CHF 1) dyspnea on exertion 2) orthopnea 3) parox nocturnal dyspnea 4) edema LA Dilation 1) afib

treatment of mitral regurg- meds

diuretics for CHF decr afterload (ACE inhib, ARB)

treatment of mitral regurg- surgery

mitral valve repair (preferred) or replacement

surgical indication for chronic Mitral regurg

1) sx 2) LV dilation 3) decr LV systolic fxn 4) new afib 5) pulm HTN

tricuspid valve fxn

open in diastole for RA--> RV close in systole to prevent backflow blood into RA

tricuspid regurg

during systole, blood backflow into RA

complications of tricuspid regurg

incr RA pressure --> incr venous pressure

sx of tricuspid regurg

1) LE edema 2) ascites 3) hepatic congestion (from high RA Pressure) 4) Palpitations 5) Fatigue (low CO) 6) RV enlargement and RV dysfunction

etiology of tricuspid regurg

1) 80% cases fxnal (no problems with tricuspid valve) due to annular dilation and leaflet restriction from RV P + V overload

murmur in tricuspid regurg

holocystolic murmur along sternal border louder with inspiration b/c inspiration incr venous return to R heart

physical exam in tricuspid regurg

1) JVD with v wave (blood back up) | 2) hepatomegaly

treatment of tricuspid regurg

if functional, 1) treat underlying cause of RV pressure overload ``` meds = diuretics surgery = tricuspid repair (more common)/replacement ```

tricuspid stenosis cause

rheumatic heart disease

tricuspid stenosis murmur

similar to mitral stenosis (heard near sternum) incr with inspiration

sx of tricuspid stenosis

1) dyspnea 2) edema 3) with mitral stenosis

treatment of tricuspid stenosis

1) diuretics | 2) tricuspid valve surgery

aortic insufficiency secondary to (2)

1) valvular disease | 2) aortic root disease

what test to measure aortic insufficiency severity and ventricular dilation/dysfunction

echo

indications for aortic valve replacement

1) sx 2) LV dilation 3) LV dysfunction

If pulmonary hypertension has developed in mitral stenosis what happens on exam?

1) loud P2 2) RV thrill or lift 3) JVD 4) tricuspid regurgitation murmur

mitral valve prolpase define

XS mitral leaflet tissue so movement of mitral leaflets into LA during systole

mitral valve prolapse mostly sporadic or hereditary

sporadic VERY BENIGN!!!!!!

mitral valve murmur

1) midsystolic click (sudden tensing of chordae tendinae + leaflet) 2) late systolic murmur

symptoms of mitral valve prolapse if problems arise

1) atrial arrhythmias (a-fib) 2) LV dilation, dysfunction 3) HF (dyspnea, orthopnea, edema)

symptoms of functional mitral regurgitation

1) S3, S4 2) loud P2 if pulmonary hypertension present 3) lateral displacement of apical impulse 4) edema, crackles, JVD

manuevers that make mitral valve prolapse murmur louder

decr LV size intensify and prolong murmur 1) valsalva 2) dehydration

manuevers that make mitral valve prolapse murmur quieter

1) squatting | 2) hydration

treatments for functional mitral regurgitation

1) meds to treat underlying cardiomyopathy ``` ACE inhib beta blockers spironolactone revascularization biventricular pacing ``` 2) Surgery with severe symptomatic MR + persistent NYHA 3-4