Mitral &Tricuspid Valve Disease

Question 1

What are the basic components of the mitral valve?

Answer 1

1. Annulus (fibrous ring around valve)
2. Leaflets
3. Chordae
4. Papillary muscles

Question 2

What is the normal function of the mitral valve?

Answer 2

1. Opens during Diastole (blood goes from LA–> LV)
2. Closes during Systole

Question 3

What is mitral valve stenosis?

Answer 3

Decreased valve opening. Preventing normal flow from LA to LV.

Increased pressure in LA.

Question 4

What are the most common causes of Mitral Stenosis?

Answer 4

1. Rheumatic MS (80-99%)
2. Calcific MS (~3%)

Question 5

What causes Rheumatic Fever (which causes Rheumatic stenosis)?

Answer 5

Group A Strep. Remember from last unit?

As a bonus, can you name the Jones Critera associated with Rheumatic fever?

J-joints

♥- Heart

N-Nodues

E-Erythema margination

S-Sydenham’s Corea

Question 6

How does a patient with Mitral Stenosis present to the clinic?

Answer 6

1. Dyspnea
   
   • Caused by High LA pressure and Pulmonary edema
2. Hemoptysis (coughing up blood)
   
   • Caused by inc pulmonary pressures and rupture of bronchial vein.
3. Pulmonary Hypertension
4. RHF (edema, ascites)

Question 7

Decreased blood flow and increased LA pressures in Mitral Stenosis puts patients at risk for developing _______&_______.

Answer 7

Inc Pressure –> A-fib

Dec Flow–> Stroke/clot formation

Question 8

In a patient with Mitral Stenosis, what abnormal findings would you expect to find during ascultation?

Answer 8

1. Loud S1
2. Opening Snap followed by diastolic rumble

Question 9

True or False:

In Mitral stenosis, the leaflets lose compliance and decrease the size of the opening.

Answer 9

True.

The opening of the valve is much smaller (called “fish-mouth opening”) in MS when compared to normal.

Question 10

What is the main medication for treating mitral stenosis?

Answer 10

Beta-blockers- slow down heart to allow more blood to flow through the valve.

Also use diuretics to treat CHF symptoms and Anticoags if A-fib is present.

Question 11

What procedural operations are involved with Mitral Stenosis intervention?

Answer 11

1. Ballon Valvuloplasty (typically done with rhuematic MS becaue valve isnt calcified, so you just rip the fusions between leaflets)
2. Mitral valve Replacement

Question 12

What is the most common cause of Primary Mitral Regurgitation?

Answer 12

Mitral Valve Prolapse

Question 14

What is the most common cause of Functional Mitral Regurgitation?

Answer 14

Severe LV dysfuntion and dilation

Question 15

What is the halmark noise of a mitral valve prolapse on ascultation?

Answer 15

Midsystolic Click followed by a systolic murmur

Question 16

What is the clinical presentation of a patient with Mitral Regurgitation? How do you treat?

Answer 16

Presentation: CHF symptoms

Treatment:

• Diuretics and Afterload reduction
• Surgically repair MV (repair is favored compared to replace)

Question 17

What is the difference between Primary and functional Valve disease?

Answer 17

Primary: Something is physically wrong with the valve

Functional: Caused by problems with Left Ventricle (dilation, dysfunction)

Question 18

What is the most common cause of tricuspid valve regurgitation?

Answer 18

RV pressure/volume overload.

Question 19

What physical exam finding is common in tricuspid regurgitation?

Answer 19

Holosystolic murmur along sternal border that increases with inspiration.

Question 20

How does a patient with Tricuspid regurgitation present in a clinic?

Answer 20

Dyspnea, Edema, Ascites, liver dysfunction (possible hepatomegaly)

Question 21

How do you treat tricuspid regurgitation?

Answer 21

Meds: Diuretics

Surgery: Repair at the time of mitral valve repair.

Question 22

What is the main cause of tricuspid stenosis?

The tricuspid stenosis murmur is similar to _________ murmur.

Prevalent or Rare?

How do you treat it?

Answer 22

Rheumatic fever

Similar to mitral stenosis murmur

RARE

Diuretics or surgery when doing mitral valve operations.

Note all these are on one card because she didnt really care about this too much.