Mitral Valve disorders Flashcards
What is mitral regurgitation?
Incomplete closure of the mitral valve leading to blood leaking from the left ventricle to the left atrirum during systole
What is the difference between primary and secondary mitral regurgitation?
- Parimary
- cuased by direct involvement of the mitral valve leaflets or the chorda tendinae
- Secondary
- caused by changed to the left ventricle that lead to valvular incompetence
What are possible reasons for primary mitral regurgitation?
Primary = direct involvement of valve or chorda tendinae
- degerneration of mitral valve
- Rheumatic fever
- Infective endocarditis
- Ischemic (e.g. leading to rupture of papillary muscle due toMI)
All normally due to Mitral valve prolapse (one leaflet going back into atrium)
What are possible reasons for secondary mitral regurgitation?
Secondary: due to changes of the left ventricle
- Coronary artery disease/ MI to cause rupture of papillary muscle
- dilated cardiomyopathy, left ventricular failure
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What is the effect of acute Mitral regurgitation?
Leads to volume overload and acute symptoms of heart failure
What is the effect of chronic Mitral regurgitation?
First compensated
- compensatory changes to right ventricle –> remodelling (with preserved CO)
- After time leading to heart failure (via impact on LVEF)
What are symptoms of mitral regurgitation?
- SOB
- other symptoms of left-sided HF
- Palpitations
- new-onset AF is common in patients with MR
- If development of cardiogenic shock
- syncope
- fatigue
What are signs of mitral regurgitation on examination?
- Pulmoary oedema
- cyanosis
- bine basillar, fine crackels end-inspiratory on ausculation
- poor peripheral perfusion (sign of HF)
- Tachycardia, Tachypneu, Hypotension (cardiac shock)
- displacement of apex beat
Which cardiac murmor would you hear on auscultation in a patient with Mitral regurgitation?
Pansystolic murmor
- often with mid-sytolic “click”
- mitral valve going back into atrium and is suddenly stoped
- roll patient on left side and listen over mitral valve
- might radiate to axilla
- migh be louder with increasing after and/ or preload
What are appropriate investigations you would order in a patient with mitral regurgitation?
- ECG
- left ventricular hypertrophy and ?AF –> migh develop with MR
- prior infarction?
- Echo (TTE)
- CXR
- Bloods
- trop
- bnp
What is the epidemiology of mitral regurgitation?
Unknown, common (More than 5 Million World wide)
What is mitral stenosis?
Hardening/ stiffness of the mitral valve
- less blood can enter the left ventricle due to reduction in opening of mitral valve
What is the problem with mitral stenosis?
Reduced filling of left ventricle in diastole
What are the most common causes for mitral stensis?
-
Rheumatic fever
- most common
- Autoimmune diseases (SLE, RA)
- Congenital abnormal mitral valve
- Rare things might mimmic MS:
- bacterial endocarditis of mitral valve, atrial myxoma (cancer)
What are risk factors for developing mitral stenosis?
- Female sex
- Streptococcal infection
- Rheumatic fever (symptom onset often 10 years after)
- Autoimmune disease
- Congenital abnormaliy
- Aortic stenosis (correlation found)
Explain the pathophysiological processes that occur in Mitral stenosis
- Reduced filling of LV
- leading to reduced stroke volume
- leading to decreased CO (forward HF)
- Congestion of blood in pulmonary circultaiton
- pulmonary oedema
- might lead to right heart failure (backwards) with right ventricular hypertrophy
What are symptoms of Mitral stenosis?
- Initially asymptomatic (+compensated, oftten only 10 years after rheumatic fever)
- Dyspnoea
- Syncopes, dizziness,
- Dyspagia
- Compression of the esophagus by the enlarged left atrium
Later: signs and symptoms of RHF
What are signs on examination of mitral stenosis?
- Lungs
- Haemoptesis
- bibalsal end-expiratory fine crackels
- Hoarse voice (compression of recurrent laryngeal nerve by enlarged right atrium)
- Mitral facies
- Mauve discoloration of the cheeks due to low cardiac output and systemic vasoconstriction (picture)
- AF, embolic complications
- Cyanosis
What are findings on auscultation in a patient with mitral stenosis
- Pulmonary oedema
- Murmors
- Dyastolic murmor when patient lies on left
- Loud first S1
- Opening snap (OS) after S2
- (the shorter between S2 and snap, the more sever MS)
- All best heard over apex
Which investigations would you order in a patient with mitral valve stenosis?
- ECG
- look for signs of HF
- CXR
- cardiomegaly? pulmonary oedema? Compression of other structures?(Picture left atrial enlargement)
- Echo (TEE)
What is the epidemiology of mitral stenosis?
- More common in developing countries
- mostly caused by rheumatic fever
