Mitral valve disease

Question 1

Mitral stenosis

Answer 1

Obstruction of blood flow across the mitral valve from left atrium to left ventricle

Question 2

Causes of mitral stenosis

Answer 2

Rheumatic fever (main cause)

Infective endocarditis

Question 3

Mitral stenosis murmur

Answer 3

Mid-diastolic, low-pitched ‘rumbling murmur

Loud S1 due to thick valves requiring large force to shut them

Question 4

Features of mitral stenosis

Answer 4

Dyspnoea

Haemoptysis (due to pulmonary pressures and vascular congestion)

Mid-late diastolic murmur

Loud S1

Malar flush

Atrial fibrillation

Question 5

Malar flush

Answer 5

Due to back-pressure of blood into pulmonary system causing rise in CO2 and vasodilation

Question 6

Management of mitral stenosis

Answer 6

Anticoagulation if associated af (warfarin for moderate/ severe MS)

Monitor asymptomatic patients

Surgical intervention for symptomatic patients

Question 7

Mitral stenosis surgical intervention

Answer 7

Percutaneous mitral balloon valvotomy

Mitral valve surgery

Question 8

Mitral regurgitation

Answer 8

Blood leaks back through the mitral valve on systole

Second most common valve disease

Question 9

Risk factors for mitral regurgitation

Answer 9

Female sex

Lower body mass

Age

Renal dysfunction

Prior MI

Prior mitral stenosis or valve prolapse

Marfan’s or EDS

Question 10

Symptoms of mitral regurgitation

Answer 10

Mostly asymptomatic

Fatigue, SOB and oedema

Question 11

Signs of mitral regurgitation

Answer 11

Pansystolic ‘blowing’ murmur heard best at apex and radiates to axilla

Quiet S1 as result of incomplete closure of valve

Question 12

Investigations for mitral regurgitation

Answer 12

ECG: broad p waves (atrial enlargement)

CXR: cardiomegaly

Echocardiogram crucial to diagnose and assess severity

Question 13

Mitral regurgitation medical management

Answer 13

Acute cases: nitrates, duiretics, positive inotropes and an intra-aortic balloon pump to increase cardiac output

In HF: ACEi with beta-blockers and spironolactone

Question 14

Surgical management of mitral regurgitation

Answer 14

Evidence for repair over replacement is strong in degenerative regurgitation (lower mortality and higher survival rates)

If not possible then valve replacement

Question 15

Mitral valve prolapse association

Answer 15

Congenital heart disease

Cardiomyopathy

Turner’s

Marfan’s

EDS

Fragile X

Osteogenesis imperfecta

WPW syndrome

Long QT syndrome

Polycystic kidney disease

Question 16

Features of mitral valve prolapse

Answer 16

Atypical chest pain or palpitations

Mid-systolic click

Late systolic murmur

Question 17

Complications of mitral valve prolapse

Answer 17

Mitral regurgitation

Arrhythmias (including long QT)

Emboli

Sudden death