Mitral valve disease

Question 1

what are the etiologies of mitral regurg?

Answer 1

rheumatic disease 
infective endocarditis 
collagen vascular disease 
cardiomyopathy 
ischemic heart disease 
mitral valve prolapse

Question 2

which conditions affect the mitral valve leaflets in MR?

Answer 2

chronic rheumatic heart disease

infective endocarditis

Question 3

which conditions affect the mitral annulus in MR?

Answer 3

dilation

calcification

Question 4

what is the pathophysiology of MR?

Answer 4

1. impedance to LV ejection (afterload) is LOWERED

2. eventual LV decompensation and failure occur

Question 5

in early MR is the ejection fraction high or low?

Answer 5

high

Question 6

what are the hemodynamics of severe, symptomatic MR?

Answer 6

1. ejection fraction normal to low
2. excess volume maintained in LA and pulmonary circulation
3. LV goes into diastolic overload and fails

Question 7

how does regurgitation of blood into LA relate to LA end systolic pressure and volume in MR?

Answer 7

higher LA end systolic pressure and volume

Question 8

what is the principal symptom of MR?

Answer 8

dyspnea

Question 9

what do the carotid artery pulses feel like in MR? why?

Answer 9

sharp in severe MR

higher SVs

Question 10

what is heard upon auscultation in MR?

Answer 10

S1 - commonly soft if MV leaflets still flexible
S2 - widely split (earlier A2)
A2 commonly softer than P2 if pulmonary HTN
S3 is common in LV
tricuspid murmur
S4 in RV (pumonary HTN)

Question 11

what are the features of the murmur heard in MR?

Answer 11

holosystolic 
blowing, loudest at apex 
radiates to axilla 
commences with S1 
occasionally lasts through S2 
constant loudness 

occasionally, patients with MR will have a diastolic murmur commencing with S3

Question 12

which is more important for a murmur - intensity or duration?

Answer 12

duration

Question 13

what are the CXR features of MR?

Answer 13

enlarged LA

possibly mitral annulus calcification

Question 14

what is the best test for MR?

Answer 14

echo

Question 15

what is the general treatment for MR?

Answer 15

afterload reduction - ACE inhibitors

nitroprusside if acute
dobutamine if hypotensive

Question 16

what is the main cause of mitral stenosis?

Answer 16

rheumatic fever

Question 17

what is the pathophysiology of mitral stenosis?

Answer 17

obstruction to LV inflow leading to pressure gradient across the valve

Question 18

what is the surface area of the MV orifice in mild mitral stenosis? critical?

Answer 18

mild - 2 cm squared

critical - 1 cm squared or less

Question 19

what may be the first symptom of mitral stenosis?

Answer 19

embolization

Question 20

systemic embolization in the context of mitral stenosis is related to what factors?

Answer 20

1. size of LA appendage
2. level of cardiac output
3. presence of atrial fibrillation

Question 21

what are the physical exam findings in mitral stenosis?

Answer 21

mitral facies
arterial pulses normal to reduced
apical impulse is onconspicuous to absent

Question 22

what is pathognomonic for mitral stenosis?

Answer 22

loud S1
opening snap at apex after P2 but before S3
S4 in RV (pulmonary HTN)

Question 23

where / how is the murmur for mitral stenosis heard?

Answer 23

low pitched, rumblinb, mid-diastolic heard with bell at LV apex in LLD

Question 24

what is a graham-steell murmur a sign of?

Answer 24

severe pulmonary HTN

Question 25

what test is the cornerstone of mitral stenosis diagnosis?

Answer 25

echo