mitral valve disease

Question 1

etiology of MS?

Answer 1

most common rheumatic fever and rare congenital disease, calcification and fibrosis of valve.

Question 2

normal orifice of mitral valve?

Answer 2

4-6cm2 in severe it reduce to 1-2cm2

Question 3

clinical features of MS?

Answer 3

1-exertional dyspnea due to venous hypertension and congestion
2-hemoptysis: sudden hemorrhage due to rapture of bronical veins, blood stained sputum due to PND, blood stained frothy sputum due to pulmonary edema, chronic bronchitis
3-chest pain due to severe right ventricular hypertension
4-palpitations due to large volume of blood in left atrium which required powerful contraction
5-systemic embolization
6-right heart failure
7-hoarsness due to compression of recurrent laryngeal nerve with dilated left atrium

Question 4

finding on examination of MS patient?

Answer 4

apex beat is not displaced
character is tapping
left parasternal heave due to right ventricular hypertrophy
palpable P2 if pulmonary hypertension exist
diastolic murmur because blood hit stenosed valve during diastole
loud S1-S2 loud P2
mid diastolic rumbling murmur

Question 5

what is silent MS?

Answer 5

in right ventricular hypertrophy it occupies the apex beat and left ventricle shift posteriorly thats why murmur not audiable

Question 6

what is graham-steel murmur?

Answer 6

it is an early distolic murmur due to pulmonary hypertension because of pulmonary regurgitation

Question 7

complications of MS?

Answer 7

atrial fibrillation
pulmonary hypertension
systemic embolization
pulmonary infarction
chest infection
infective endocarditis
tricuspid regurgitation
RVF

Question 8

investigation?

Answer 8

xray shows mitralization which means straightening of left heart boarder, small heart with enlarged left atrium, kerley’s B line
echo is diagnostic
doppler echo to measure pulmonary artery pressure
TEE

Question 9

management?

Answer 9

medical treatment: salt restriction, low dose of diuretics, b-blocker for heart rate, anti coagulant for embolization
surgical include: percutaneous balloon valvotomy, mitral valve replacement

Question 10

causes of mitral regurgitation?

Answer 10

chronic: rheumatic fever, mitral valve prolapse, myocarditis, HTN, dilated cardiomyopathy, ischemic heart disease
acute:MI and infective endocarditis
less common causes: marfan syndrome, ehlers danlos syndrome, sle, rheumatoid arthritis

Question 11

clinical features?

Answer 11

palpitations, exertional dyspnea, fatigue and lethargy, hemoptysis, symptoms of right heart failure and in acute cause pulmonary edema

Question 12

examination finding?

Answer 12

apex beat displace outside the midclavicular line due to left ventricular dilation
parasternal impulse, palpable p2 in case of pul htn
1st heart sound is soft, loud S3
pansystolic murmur due to regurgitation occur in whole systole

Question 13

investigation?

Answer 13

xray chest
ecg
echo

Question 14

management of MR?

Answer 14

ACE inhibitors
b blocker
diuretics
oral anticoagulants
antibiotics prophylaxis

Question 15

surgical indication of MR?

Answer 15

acute MR
EF30-50% and end diastolic dimenstions 45-50mm2
pt who developed pulmonary hypertensio of more than 50mmhg