Mitral Valve Diseases

Question 1

Regurgitation presentation

Answer 1

Pansystolic murmur at apex radiate to axilla
Displaced Hyperdynamic apex(DCM - hypodynamic apex)
Soft S1
Wide split S2
Atrial fibrillation
If PHT - Loud P2 & parasternal heave

Question 2

Regurge causes

Answer 2

Rheumatic fever
Infective endocarditis 
Mitral valve prolapse 
Ehlers-Danlos 
Marfan’s syndrome
Dilated cardiomyopathy(peri-partum)

Question 3

Regurge tests

Answer 3

ECG: AFib, P-mitrale, LVH
CXR: big LA & LV, mitral valve calcification, pulmonary oedema
Echo: Assess LV function, MR severity & cause
Cardiac catheterization: confirm Dx, exclude other valve diseases, assess CAD

Question 4

Regurge Rx

Answer 4

Control rate if AF
Diuretics
Surgical replacement

Question 5

Prolapse Sx

Answer 5

Asymptomatic/ atypical chest pain, palpitations, autonomic dysfunction
Mid-systolic click
OR late systolic murmur

Question 6

Prolapse causes

Answer 6

ASD
PDA
Cardiomyopathy 
Turner’s syndrome
Marfan’s syndrome
Osteogenesis Imperfecta
WPW

Question 7

Prolapse Dx

Answer 7

Echo: Diagnostic
ECG: Inferior T-wave inversion

Question 8

Prolapse Rx

Answer 8

Beta-blockers for palpitations + chest pain

Surgery if severe MR

Question 9

Prolapse complications

Answer 9

Mitral regurge
Cerebral Emboli
Arrhythmias
Sudden death

Question 10

Stenosis sx

Answer 10

Dyspnoea
Dysphagia
Hoarseness
Bronchial obstruction
Fatigue
Systemic emboli

Question 11

Stenosis clinical sx

Answer 11

Malar flush on cheeks
AFib
Low to normal volume pulse
Tapping non-displaced apex
RV heave (parasternal)
Loud S1 (palpable at apex)
Opening snap
Rumbling mid-diastolic murmur + presystolic accentuation(PSA)
Graham-Steell murmur: EDM => pulm regurge 2nd to PHT => Stenosis
Severe: longer diastolic murmur + opening snap closer to S2

Question 12

Stenosis causes

Answer 12

Rheumatic fever
Congenital
SLE
RA
Bact endocarditis of mitral valve

Question 13

Stenosis Dx

Answer 13

ECG: AFib, P-Mitrale, RVH, Progressive RAD
CXR: LA enlarge, double shadow in right cardiac silhouette, pulmonary oedema, valve calcification
Echo: Diagnostic,
Cardiac catheterization indications: other valve disease sx, angina, severe PHT, calcified mitral valve, prev valvotomy

Question 14

Stenosis Rx

Answer 14

AFib: rate control, 
Anticoagulate w warfarin
Diuretics for HF
B-blockers, CCB’s
Percutaneous valve commissurotomy 
Balloon valvuloplasty

Question 15

Stenosis complications

Answer 15

AFib -> Thromboembolic events
Pulm oedema
Pulm HPT
CCF
Enlarged LA