Mitral Valve Disease - Regurgitation Flashcards
When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S1 relate to?
1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves
1 - closing of the tricuspid and mitral valves
- also called the atrioventricular valves, as these 2 valves relate to the atrium
Does the S1 heart sound occur at the start of diastole or systole?
- systole
- mitral and tricuspid valves close to stop blood moving back into the atrium
When we listen to the heart we should be able to hear 2 separate sounds, S1 and S2. What does S2 relate to?
1 - closing of the tricuspid and mitral valves
2 - closing of tricuspid and aortic valves
3 - closing of mitral and aortic valves
4 - closing of aortic and pulmonary valves
4 - closing of aortic and pulmonary valves
Does the S2 heart sound occur at the start of diastole or systole?
- diastole
- aortic and pulmonary valves close to allow atria to pump blood into ventricles
In some patients a 3rd heart sound can be heard, S3, which occurs just after S2. What causes this 3rd heart sound?
1 - mitral regurgitation
2 - ventricular septal defect
3 - chordae tendineae pulling
4 - aortic regurgitation
3 - chordae tendineae pulling
- papillary muscles contract and pull chordae tendineae which attach to mitral valves
- sound is because they pull so hard to fully expand the left ventricle
- can be heard in some younger patients, BUT can signify HR in older patients
How many leaflets does the mitral valve have?
1 - 4
2 - 3
3 - 2
4 - 1
3 - 2
- anterior and posterior leaflets
Does the mitral valve open during systole or diastole?
- diastole
- pumps blood into LV
Does the aortic valve close during systole or diastole?
- diastole
- allows left ventricle to be filled
Does the mitral valve close during systole or diastole?
- systole
- closes so blood can be pumped from LV to the body
In mitral regurgitation we would expect to hear a murmur. When would we typically hear this murmur?
1 - start of S1
2 - throughout S1 to S2
3 - between S2 and S1
4 - just after S2
2 - throughout S1 to S2
- this valve should be closed throughout systole
this is a pan-systolic murmur
In mitral regurgitation we would expect to hear a pansystolic murmur throughout S1 to S2. Where is the best place to hear this murmur?
1 - left parasternal border
2 - erbs point
3 - right parasternal border
4 - axilla/apex of heart
4 - axilla/apex of heart
- heard even better if patient rolls to the left
What os the most common cause mitral regurgitation?
1 - idiopathic/degenerative
2 - rheumatic
3 - congenital
4 - endocarditis
1 - idiopathic/degenerative
All of the following can cause mitral regurgitation, EXCEPT which one?
1 - congenital defect causing 3 leaflets
2 - valve prolapse (Chordal rupture / Papillary muscle rupture
3 - acute MI (damages Chordal rupture / Papillary muscle rupture)
4 - Infective endocarditis
5 - Rheumatic fever
6 - Annular dilation
7 - LV dilation in heart failure
8 - connective tissue disorders (ehlers danlos and marfans syndrome)
1 - congenital defect causing 3 leaflets
- genetics can cause a weakening but not 3 leaflets
Although a murmur is common in systole with mitral regurgitation. Which of the following cause of mitral regurgitation can cause a click in mid systole and help identify the cause?
1 - congenital defect causing 3 leaflets
2 - valve prolapse (Chordal rupture / Papillary muscle rupture
3 - acute MI (damages Chordal rupture / Papillary muscle rupture)
4 - Infective endocarditis
2 - valve prolapse (Chordal rupture / Papillary muscle rupture
- the click is caused by leaflet folding into LA, but chordae tendineae stops this
Patients with mitral regurgitation may present with all of the following symptoms, EXCEPT which one?
1 - fatigue
2 - dyspnoea
3 - peripheral oedema
4 - palpitations
3 - peripheral oedema
- can present late as this is linked with congestive heart failure
All of the following are tests to diagnose a patient with suspected mitral regurgitation, but which generally provides a definitive diagnosis and is regularly used?
1 - echocardiogram
2 - ECG
3 - CXR
4 - transoesophageal echocardiogram
5 - cardiac catheterisation
1 - echocardiogram
As mitral regurgitation develops, the left atrium may increase in size and increase the risk of which arrhythmia?
1 - VT
2 - VF
3 - AF
4 - atrial flutter
3 - AF
Valvular repair is required for mitral regurgitation before what happens in a patient?
1 - AF
2 - significantly impaired LV function
3 - VF
4 - pulmonary hypertension
2 - significantly impaired LV function
While assessing if a patient needs a repair or replacement valve for mitral regurgitation, what medical management can be effective?
1 - diuretics
2 - anticoagulants
3 - beta blockers
4 - all of the above
4 - all of the above
- diuretics = reduces SVR and workload on heart
- anticoagulants = reduces risk of PE/stroke if AF
- beta blockers = reduces HR and risk of AF
How can left sided heart failure lead to mitral regurgitation?
1 - pressure from LV causes MV prolapse
2 - pressure in LA causes LA to dilate, pulling MV apart
3 - LV hypertrophy causes MV to stretch
4 - all of the above
2 - pressure in LA causes LA to dilate, pulling MV apart
- left sided HF also caused fluid overload and dilates both LV and LA
Complete the table below using the labels below using systole or diastole of when you would hear the murmurs:
