Mitral Valve Disease - Regurgitation

Question 1

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

Answer 1

1 - closing of the tricuspid and mitral valves
- also called the atrioventricular valves, as these 2 valves relate to the atrium

Question 2

Does the S1 heart sound occur at the start of diastole or systole?

Answer 2

• systole
• mitral and tricuspid valves close to stop blood moving back into the atrium

Question 3

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

Answer 3

4 - closing of aortic and pulmonary valves

Question 4

Does the S2 heart sound occur at the start of diastole or systole?

Answer 4

• diastole
• aortic and pulmonary valves close to allow atria to pump blood into ventricles

Question 5

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

Answer 5

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

Question 6

How many leaflets does the mitral valve have?

1 - 4
2 - 3
3 - 2
4 - 1

Answer 6

3 - 2
- anterior and posterior leaflets

Question 7

Does the mitral valve open during systole or diastole?

Answer 7

• diastole
• pumps blood into LV

Question 8

Does the aortic valve close during systole or diastole?

Answer 8

• diastole
• allows left ventricle to be filled

Question 9

Does the mitral valve close during systole or diastole?

Answer 9

• systole
• closes so blood can be pumped from LV to the body

Question 10

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

Answer 10

2 - throughout S1 to S2
- this valve should be closed throughout systole
this is a pan-systolic murmur

Question 11

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

Answer 11

4 - axilla/apex of heart
- heard even better if patient rolls to the left

Question 12

What os the most common cause mitral regurgitation?

1 - idiopathic/degenerative
2 - rheumatic
3 - congenital
4 - endocarditis

Answer 12

1 - idiopathic/degenerative

Question 13

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)

Answer 13

1 - congenital defect causing 3 leaflets
- genetics can cause a weakening but not 3 leaflets

Question 14

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

Answer 14

2 - valve prolapse (Chordal rupture / Papillary muscle rupture

• the click is caused by leaflet folding into LA, but chordae tendineae stops this

Question 15

Patients with mitral regurgitation may present with all of the following symptoms, EXCEPT which one?

1 - fatigue
2 - dyspnoea
3 - peripheral oedema
4 - palpitations

Answer 15

3 - peripheral oedema
- can present late as this is linked with congestive heart failure

Question 16

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

Answer 16

1 - echocardiogram

Question 17

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

Answer 17

3 - AF

Question 18

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

Answer 18

2 - significantly impaired LV function

Question 19

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

Answer 19

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

Question 20

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

Answer 20

2 - pressure in LA causes LA to dilate, pulling MV apart

• left sided HF also caused fluid overload and dilates both LV and LA

Question 21

Complete the table below using the labels below using systole or diastole of when you would hear the murmurs:

Answer 21