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Cardiology 2 > Mitral Valve Disease > Flashcards

Mitral Valve Disease Flashcards

1
Q

What are causes of Mitral Regurgitation?

A 
Rheumatic Disease
Infective Endocarditis
Collagen Vascular Disease
Cardiomyopathy- Mitral Annulus dilates 
Ischemic Heart Disease (pappilary muscle dys)
Mitral Valve Prolapse
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2
Q

What valve structures are involved in Mitral Regurgitation?

A 
Leaflets
-Chronic Rheumatic Heart Disease
-Infective Endocarditis
Mitral Annulus
-Dilation
-Calcification
Chordae Tendinae
-Lengthen and rupture in prolapse
-Infective Endocarditis, trauma, rupture of chordae
Papillary Muscle 
-Ischemia
-Posterior Papillary Muscle
-Rupture from MI  is usually fatal (acute pulmonary Edema)
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3
Q

What happens to the Ejection fraction as MR progresses?

A

Early- Ejection fraction is still high
Severe-EF normal to low
As excess vollume is retained in the LA andpulm circulation LV goes into diastolic overload and fails

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4
Q

What is the pricipal symptoms of Mitral Reguritation?

A

SOB(Dyspnia)

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5
Q

What are other symptoms of MR?

A 
Palpitations
Hemoptysis and systemic emboli
Angina Pectoris
S and S of RV Failure
Hepatic Edema and Ascites
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6
Q

What are physical Exam findings in MR?

A

Sharp Carotid Artery Pulses
Apical Impulse displaces to the left and down
Left systolic LA thrust palpable at left parasternal area

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7
Q

What is auscultated in mitral Regurg?

A 
S1 Soft 
S2 widely split
A2 softer than P2
S3 commonin LV
S4 in RV
HOLOSYSTOLIC MURMUR
and DIastolic Murmur commencing with S3
DURATION MORE THAN INTENSITY
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8
Q

How is MR imaged?

A

Electrogardiography

Vegitations and valves can be seen flapping around

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9
Q

What is seen on ECG in Mitral Regurgitation?

A

Negative terminal movement on P wave and atrial abnormalities

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10
Q

What are medical treatments for MR?

A

Decrease afterload (ACE-I)
Acute MR - Nitroprusside IV
If in A-Fib, Anticoagulate
Digitalis Glycosides may improve intropism and Slow A-fib

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11
Q

Waht is surgical Treatment for MR?

A

Mitral Valve Repair
Don’t replace valve as often anymore
Need to be aware of the Coronary vessels BEFORE you start surgery
Can do an annuloplasty and/or reconstruction of cusps
Prolapsing or redundant valve cusps resected.

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12
Q

What are complications of Valve replacement?

A

Calcification
LV function deterioration from loss of integrity of annulus-chordae-papillary muscle apparatus

Mechanical valves require anticoagulation
tissue valves degenerate
all types prone to endocarditis

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13
Q

What is the most common cause of Mitral Stenosis?

A

Rheumatic Fever

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14
Q

What are the 4 forms of MV stenosis?

A

Commisural
Cusps
Chordal
Combined

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15
Q

What are the conditions that mimic Mitral Stenosis?

A

Left atrial Myxoma
Left atrial ball-valve thrombus
infective endocarditis with large vegitations
cor triatrium (congenital)

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16
Q

What happens to the Diameter of the Mitral Valve in Mitral Stenosis?

A

Normal 4-6cm2

1-2 cm sq or less

17
Q

What is seen in the history of Mitral Stenosis?

A

Systemic EMBOLIZATION
Endocarditis
Chest Pain
Hemoptysis

18
Q

What are the points of Virchow’s Triad of intrathelial/Intracardial embolization?

A

Stasis of Flow
Hypercoaguable state
Endothelial Injury

19
Q

What is seen on PE of Mitral Stenosis?

A

Mitral Facies: Purple-pink cheeks
Arterial pulses reduced?
Apical pulse is inconspicuous to absent

20
Q

What is Auscultated in Mitral Stenosis?

A

S1 is LOUD
Opening Snap

Diastolic Murmur of MS
Duration of murmur correlates with degree of stenosis
Grahm Steel Murmur
Tricuspid Murmur

21
Q

What will imaging show in Mitral Stenosis?

A

CXR LA enlarged

ECHOCARDIOGRAPHY
Thickened or calcified MV leaflets separate poorly in diastole
Inc LA size
Thrombus in LA appendage
HOCKEY STICK SIGN

Doppler techniques can delineate MR, AR, other valve lesions

22
Q

What is seen on ECG in Mitral Stenosis?

A

Left atrial Abnormality of P wave with a divot(double bump mitral). II and V1
Deep terminal P force in V1

23
Q

What is different about prevalence of Mitral Stenosis in Tropical Climates?

A

MS is seen in children

24
Q

What is Tx of Mitral Stenosis

A 
Prophylaxis against infective endocardiitis and B hemolytic Strep
Avoid strenuous activity
Anticoagulants for prophylaxis against emboli (esp stroke)
BEFORE CARDIOVERSION
Maint Sinus Rhythm
Reduce salt and Water intake
DO NOT Become pregnant
Beta Blockers
25
Q

What is the Surgical Treatment for Mitral Stenosis?

A 
Valve Surgery
Coronary angiogram if 
--Difference between Clinical and Echo Findings
Angina 
Men >40, Women >50 with Risk factors for CAD
Baloon Valvotomy
Closed/open Valvotomy
MV Replacement

Cardiology 2 (16 decks)

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