Mitral Valve Disease

Question 1

What is mitral regurgitation?

Answer 1

• Incompetent mitral valve allows blood to leak back during systolic contraction of left ventricle

Question 2

What are the causes of MR?

Answer 2

• LV dilatation
• Mitral annular calcification
• IHD
• Rheumatic fever
• Infective endocarditis
• MItral valve prolapse
• ruptured cordae tendinae
• papillary muscle dysfunction
• Ehler’s danlos, Marfan’s

Question 4

Sx of MR

Answer 4

• Dyspnoea
• fatigue
• palpitations

Question 5

Sound of MR

Answer 5

• pan-systolic high pitched whistling murmur @ apex, radiating to axilla
• soft S1, split S2, loud P2
• best heard with diaphragm

Question 6

What does pan-systolic mean?

Answer 6

• persistent throughout

Question 7

What are the signs of MR?

Answer 7

• AF
• displaced apex beat

Question 8

What test will you order for MR?

Answer 8

• ECG
  
  • AF
  • p-mitrale
  • LVH
• CXR
  
  • big LA
  • big RA & LV
  • mitra valve calcification
  • pulmonary oedema
• Echocardiogram
• Cardiac catheterizaiton

Question 9

How would you mx MR?

Answer 9

• Control rate for fast AF
  
  • beta blockers, digoxin, verapamil
• Anticoagulate if AF
  
  • abixaban, dabigatran, rivaroxiban
• Diuretics
• Prosthetic valve

Question 10

What is the most common valvular abnormality?

Answer 10

• mitral valve prolapse

Question 11

What is mitral valve prolapse associated with?

Answer 11

• Arterioseptal defect
• PDA
• cardiomyopathy
• Turner’s syndrome, Marfan’s syndrome
• osteogenesis imperfecta
• WPW

Question 12

What sound will you hear for Mitral Valve Prolapse?

Answer 12

• Mid systolic click
• late systolic murmur
• Heard @ cardiac apex with diaphragm

Question 13

What are the cx of MVP?

Answer 13

• MR
• cerebral emboli
• arrhythmias
• sudden death

Question 14

What is mitral stenosis?

Answer 14

• narrow mitral valve making it difficult for LA to push blood through ventricles

Question 15

What causes MS?

Answer 15

• Rheumatic fever (most common)
• Infective endocarditis
• Prosthetic valve

Question 16

What are the sx for MS?

Answer 16

• Pulmonary HTN
  
  • dyspnoea
  • haemoptysis
  • hoarness
  • dysphagia
  • bronchial obstruction
  • palpitations
  • chest pain

Question 17

What are the signs for MS?

Answer 17

• Mitral facies - decrease CO
• AF - due to L atrial dilatation
• Raised JVP
• Peripheral oedema
• Diastolic murmur c opening snap

Question 18

What sound does MS generate?

Answer 18

• rumbling mid-diastolic murmur
• heard with bell
• more severe the stenosis, more longer the diastolic murmur

Question 19

What test would you order for MS?

Answer 19

• ECG
  
  • AF
  • P-mitrale
  • RVH
  • progressive R atrial dilation
• CXR
  
  • left atrial enlargement
  • pulmonary oedema
  • mitral valve calcification
• Echo
• cardiac catheterization

Question 20

How would you Mx MS?

Answer 20

• rate control if AF
• anticoagulate with warfarin
• diuretics
• balloon valvuloplasty
  
  • if pt symptomatic, valve is mobile and non-calcified
• Mitral valve repair
  
  • if anatomy unsuited for balloon
• valve replacement
  
  • if severe sx