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SPR2015 > Mitral & Tricuspid valve disease > Flashcards

Mitral & Tricuspid valve disease Flashcards

1
Q

Mitral valve anatomy

A

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

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2
Q

what does mitral valve separate?

A

LA and LV

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3
Q

when does mitral valve open and when does it close

A

open in diastole

close in systole (prevent backflow)

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4
Q

what happen in mitral stenosis

A

decr mitral valve open

obstruct flow from LA to LV

incr Pressure in LA, pulm vasculature, right heart

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5
Q

most common etiology of mitral stenosis

A

rheumatic MS

calcific MS (old age and renal disease)

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6
Q

causes of rheumatic stenosis

A

acute rheumatic fever (only 50%)

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7
Q

what is acute rheum fever

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

2-3 wk after strep throat

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8
Q

effect of acute rheum fever in heaeart

A

inflammation of valvular endocardium –> chronic rheum heart disease

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9
Q

clinical effect of mitral stenosis

A

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

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10
Q

what causes dyspnea in mitral stenosis

A

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

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11
Q

what causes hemoptysis in mitral stenosis

A

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

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12
Q

what causes right sided heart failure in mitral stenosis

A

RV pump against high resistance from pulm HTN

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13
Q

what causes afib in mitral stenosis

A

chronically high LA pressure –> LA dilation

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14
Q

what causes emb stroke in mitral stenosis

A

stagnant blood flow in LA –> blood clot

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15
Q

what heart sound with mitral stenosis

A

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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16
Q

severity of MS inversely proportional to ____

A

interval between S2 and opening snap

high LA pressure opens valve earlier

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17
Q

Mitral stenosis on ekg?

A

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

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18
Q

Mitral stenosis on echo?

A

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

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19
Q

mitral stenosis treatment

A

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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20
Q

types of mitral valve stenosis interventions

A

percutaneous balloon mitral valvuloplasty vs. valve replacement

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21
Q

define percutaneous balloon mitral valvuloplasty

A

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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22
Q

indications for intervention with mitral stenosis

A

1) sx
2) afib
3) pulm HTN

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23
Q

mitral regurg define

A

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

24
Q

causes of mitral regurg?

A

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)

25
Q

mitral regurg physical exam

A

holocystolic murmur heard at apex and radiate to axilla

26
Q

mitral valve prolapse

A

asymptomatic and benign

concern for mitral regurg

27
Q

hemodynamics of mitral regurg

A

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

28
Q

clinical effect of mitral regurg

A

CHF

1) dyspnea on exertion
2) orthopnea
3) parox nocturnal dyspnea
4) edema

LA Dilation
1) afib

29
Q

treatment of mitral regurg- meds

A

diuretics for CHF

decr afterload (ACE inhib, ARB)

30
Q

treatment of mitral regurg- surgery

A

mitral valve repair (preferred) or replacement

31
Q

surgical indication for chronic Mitral regurg

A

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

32
Q

tricuspid valve fxn

A

open in diastole for RA–> RV

close in systole to prevent backflow blood into RA

33
Q

tricuspid regurg

A

during systole, blood backflow into RA

34
Q

complications of tricuspid regurg

A

incr RA pressure –> incr venous pressure

35
Q

sx of tricuspid regurg

A

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

36
Q

etiology of tricuspid regurg

A

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

37
Q

murmur in tricuspid regurg

A

holocystolic murmur along sternal border

louder with inspiration b/c inspiration incr venous return to R heart

38
Q

physical exam in tricuspid regurg

A

1) JVD with v wave (blood back up)

2) hepatomegaly

39
Q

treatment of tricuspid regurg

A

if functional,
1) treat underlying cause of RV pressure overload

meds = diuretics
surgery = tricuspid repair (more common)/replacement
40
Q

tricuspid stenosis cause

A

rheumatic heart disease

41
Q

tricuspid stenosis murmur

A

similar to mitral stenosis (heard near sternum)

incr with inspiration

42
Q

sx of tricuspid stenosis

A

1) dyspnea
2) edema
3) with mitral stenosis

43
Q

treatment of tricuspid stenosis

A

1) diuretics

2) tricuspid valve surgery

44
Q

aortic insufficiency secondary to (2)

A

1) valvular disease

2) aortic root disease

45
Q

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

A

echo

46
Q

indications for aortic valve replacement

A

1) sx
2) LV dilation
3) LV dysfunction

47
Q

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

A

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

48
Q

mitral valve prolpase define

A

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

49
Q

mitral valve prolapse mostly sporadic or hereditary

A

sporadic

VERY BENIGN!!!!!!

50
Q

mitral valve murmur

A

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

51
Q

symptoms of mitral valve prolapse if problems arise

A

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

52
Q

symptoms of functional mitral regurgitation

A

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

53
Q

manuevers that make mitral valve prolapse murmur louder

A

decr LV size intensify and prolong murmur

1) valsalva
2) dehydration

54
Q

manuevers that make mitral valve prolapse murmur quieter

A

1) squatting

2) hydration

55
Q

treatments for functional mitral regurgitation

A

1) meds to treat underlying cardiomyopathy

ACE inhib
beta blockers 
spironolactone
revascularization
biventricular pacing

2) Surgery with severe symptomatic MR + persistent NYHA 3-4

SPR2015 (23 decks)

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