Mitral Valve Disease Flashcards
What is the most common cause of mitral stenosis?
rheumatic heart disease
What is mitral stenosis?
Mitral stenosis (MS) involves narrowing of the mitral valve, which results in decreased filling of the left ventricle during systole and increased left atrial pressure (due to incomplete left atrial emptying).
What murmur is mitral stenosis associated with?
Mitral stenosis is associated with a low-pitched, rumbling, mid-diastolic murmur heard loudest over the apex.
What group of bacteria causes rheumatic fever?
group A beta-haemolytic streptococcus
Is mitral stenosis more common in men or women?
Women
What are 4 other rarer causes of mitral stenosis?
- Congenital
- Left atrial myxoma
- Connective tissue disorders
- Mucopolysaccharidosis
Where is the mitral stenosis murmur loudest on expiration?
Left lateral decubitus position
Give 6 presenting features of mitral stenosis:
1) dyspnoea
2) fatigue
3) palpitations
4) chest pain
5) haemoptysis
6) atrial fibrillation
Describe the pathophysiology of mitral valve stenosis: (2)
1) increased atrial pressure is required to pass blood through the stenosed mitral valve, causing LA hypertrophy and dilation
2) increased atrial pressure creates backlog, increasing pulmonary and right heart pressure, leading to pulmonary oedema and RV hypertrophy, dilation and failure
Give 4 clinical signs of mitral stenosis:
1) malar flush
2) small-volume pulse
3) raised JVP
4) opening snap sound of valves suddenly followed by low-pitched rumbling mid diastolic murmur
Describe the appearance of malar flush:
bilateral, cyanotic or dusky pink discolouration of upper cheeks
What does a raised JVP indicate?
right sided heart failure
Describe the technique used to auscultate the mitral valve:
use the BELL of the stethoscope at the apex of the heart with the patient lying on their left side in expiration
Describe the appearance of a CXR for mitral valve stenosis:
LA enlargement
Name 3 key investigations of valvular heart disease:
1) chest x-ray
2) echocardiogram
3) ECG
Describe how an ECG for a patient with mitral valve stenosis may present: (2)
1) bifid p wave (due to delayed left atrial activation)
2) may show signs of atrial fibrillation
Give 3 treatments for mitral valve stenosis:
1) diuretics for pulmonary oedema
2) mitral valve replacement
3) valvulotomy
What is mitral reguritation?
Mitral regurgitation (MR) occurs when there is backflow (regurgitation) of blood from the left ventricle into the left atria (through the mitral valve) during ventricular systole.
What murmur is mitral regurgitation associated with?
Mitral regurgitation is associated with a pansystolic murmur heard loudest over the mitral area and radiating to the axilla.
Abnormalities of which 4 cardiac structures can cause mitral regurgitation:
1) valve leaflets
2) annulus
3) chordae tendineae
4) papillary muscles
Give the 7 most frequent causes of mitral regurgitation:
1) ischaemic heart disease
2) calcification in old age
3) infectious endocarditis
4) rheumatic heart disease
5) cardiomyopathy
6) Marfan’s and Ehlers-Danlos syndrome
7) SLE
Describe the pathophysiology of acute mitral regurgitation: (2)
1) regurgitation into the left atrium produces left atrial dilation
2) in acute cases, the LA does not have time to dilate and compensate, leading to increased LA pressure and thus increased pulmonary pressure -> pulmonary oedema
Give 4 presenting symptoms of mitral regurgitation:
1) dyspnoea
2) orthopnoea
3) fatigue
4) lethargy
Give 6 signs of mitral regurgitation:
- Pan systolic murmur (due to regurgitation in systole)
- Soft first heart sound (incomplete closing of the mitral valve)
- prominent third heart sound (due to sudden rush of blood back in LA)
- Mid systolic click (floppy mitral valves may suddenly prolapse)
- laterally displaced forceful diffuse apex beat and systolic thrill in severe cases
- signs of AF, pulmonary hypertension and left and right heart failure develop later in disease
Give 3 methods of investigations and their positive findings for mitral regurgitation:
1) chest x-ray -> LA and LV enlargement
2) echocardiogram -> dilated LA and LV
3) ECG -> bifid p waves (LA delay) and LV hypertrophy signs
Give 3 ECG signs of LV hypertrophy:
1) tall R wave
2) deeply inverted T wave on left chest leads
3) deep S waves on right sided chest leads
What is the main treatment method for mitral regurgitation?
valve repair/replacement
What is a mitral valve prolapse?
A mitral valve prolapse occurs when the mitral valve leaflets prolapse into the left atrium during systole.
Mitral valve prolapse is associated with a combination of a mid-systolic click and mid to late-systolic murmur.
