Mitral valve disease Flashcards
What are the causes of mitral stenosis?
rheumatic fever, congenital, mucoplysaccharidoses, endocardial fibroelastosis, malignant carcinoid, prosthetic valve
How does mitral stenosis present?
dyspnoea, fatigue, palpitations, chest pain, systemic emboli, haemoptysis, chronic brnochitis-like picture +/- complications
What are the signs of mitral stenosis? What is heard on auscultation?
malar flush on cheeks, low-volume pulse, AF, tapping non-displaced apex beat (palpable S1)
On auscultation - rumbling mid-diastolic murmur best heard on expiration with the patient rolled onto their left-side, loud S1, opening snap, Graham Steell murmur may be heard
The more severe the stenosis, the longer the diastolic murmur and the close the opening snap is to S2
What would be seen on an ECG with someone who has mitral stenosis?
P-mitrale
RVH
progressive RAD
AF
What other investigations should be ordered other than an ECG and what would they show?
CXR - left atrial enlargement (double shadow in right cardiac silhouette), pulmonary oedema, mitral valve calcification
Echocardiography - diagnostic, visualisation of stenotic valve
What is the management for mitral valve stenosis?
If in AF - rate control (beta blocker or rate limiting CCB), anticoagulate (warfarin)
Diuretics - decreased preload and pulmonary venous congestion
Balloon valvuloplasty, open mitral valvotomy or valve replacement
What are the complications of mitral stenosis?
pulmonary hypertension, emboli, pressure from large LA on local structures eg hoarseness, dysphagia, bronchial obstruction, infective endocarditis
What are the causes of mitral regurgitation?
functional )LV dilatation), annular calcification, rheumatic fever, infective endocarditis, mitral valve prolapse, ruptured chordae tendinae, papillary muscle dysfunction/rupture, connective tissue disorders (Ehlers-Danlos syndrome), cardiomyopathy, congenital, appetite suppressants
What are the symptoms of mitral regurgitation?
dyspnoea, fatigue, palpitation, infective endocarditis - fever, rigors, nightsweats, malaise, weight loss, anaemia
What are the signs of mitral regurgitation?
What is heard on auscultation?
AF; displaced, hyperdynamic apex; RV heave
Auscultation - pansystolic murmur at apex radiating to the axilla, soft S1, split S2, loud P2
What would be seen on ECG and CXR that would suggest mitral regurgitation?
ECG - EF +/- P-mitrale, LVH
CXR - big LA and LV, mitral valve calcification, pulmonary oedema
How should mitral regurgitation be managed?
if fast AF - rate control.
Anticoagulants if: AF, history of embolism, prosthetic valve, additional mitral stenosis
Diuretics
Surgery if symptoms deteriorating - aim to repair or replace valve before LV irreversibly impaired
What test is done to confirm a diagnosis of mitral regurgitation?
cardiac catheterisation - confirms the diagnosis and excludes other valvular diseases and assess coronary artery disease
What is the most common valvular abnormality?
mitral valve prolapse
What is associated with mitral valve prolapse?
ASD, patent ductus arteriosus, cardiomyopathy, Turner’s syndrome, Marfan’s syndrome, osteogenesis imperfecta, pseudoxanthoma elasticum, WPW
Can occur alone
