Mitral Valve Disease Flashcards
How does mitral stenosis progress?
Pressure builds up in the Left Atrium which backs up through the pulmonary circ causing pulmonary hypertension.
As a result the Right heart dilatates with Tricuspid and pulmonary regurgitation.
What can cause mitral stenosis?
Mainly Rheumatic Heart Disease fibrosing the valve.
Also Congenital Mitral Stenosis
Occasionally systemic conditions like lupus erythematosus or rheumatoid arthritis
What are the symptoms of mitral stenosis?
Dyspnoea & Pulmonary Oedema
Haemoptisis should small veins rupture due to pulmonary hypertension
Systemic embolisation due to enlargement of LA & LAA
Chest Pain
Hoarseness (enlarged heart compresses L Recurrent Laryngeal Nerve)
What are the clinical signs of mitral stenosis?
A Diastolic Thrill & Tapping Apex Beat
A RV Heave due to dilatation
A 3rd heart sound & blowing sound durin diastole when auscultating the MV
Mitral Facies
How do we investigate suspected Mitral Stenosis?
An ECG,
CXR - LA enlargement
Echocardiogram - Thickening/Scarring of mitral leaflets
CMR
How can we treat mitral stenosis?
If in Afib then Sinus Rhythm Restortation & Anti-Coagulants
Diuretics & Low Na Intake to lower BP
Valvotomy - Widenin the valve with a baloon or surgery
Mitral Valve Replacement
When does MS often become apparent?
When the patient becomes tachycardic
What are the possible causes of mitral regurgitation?
Again Mainly Rheumatic Heart Disease
Also could be:
Mitral Valve Prolapse - Infect. Endocarditis - Degenerative Disease - Ventricle enlargement stretching the valve
What are the symptoms of Mitral Regurgitation?
Acute MR:
Dyspnoea - Pulmonary Oedema - Cardiogenic Shock
Chronic MR:
Fatigue - Exhaustion - RH enlargement & failure - Dyspnoea/Palpitations due to Afib
What are the clinical signs of mitral regurgitation?
A brisk, hyperdynamic apex beat
A RV Heave due to Hypertrophy
Upon auscultating the mitral valve, blowing at apex radiating to axilla
If RHF then high JVP + Low pulse.
What would do to investigate potential Mitral Regurgitation?
An ECG, CXR & Echo
What would appear on an MR ECG?
A tall P wave indicating LA enlargement
And a prominent R wave showing RVH
How would Mitral Regurgitation show on a CXR or Echo?
CXR: Cardiomegaly - LA enlargement - Calcified Mitral Annulus
Echo: Annular Disease - MR severity - Dysfunction of leaflets, chordae or pap muscles.
How do we treat Mitral Regurgitation?
Acute MR:
Use Na nitroprusside OR Dobatumine to lower preload/afterload
Chronic MR:
Diuretics can reduce symptoms but will still need surgery
Surgery:
Eventual will need MV repair/Replacement
