MR Flashcards
What is the primary etiology of MR?
Degenerative changes isolated to part(s) of the valvular complex
Includes myxomatous changes, prolapse, flail, ruptured or elongated chordae, and papillary muscle rupture.
What are common causes of degenerative changes in primary MR?
Calcification and thickening of valve components
These changes can lead to dysfunction of the mitral valve.
What infectious condition can lead to primary MR?
Endocarditis
This can result in destructive vegetations, leaflet perforation, or aneurysm.
Which inflammatory conditions can cause primary MR?
Rheumatic disease, collagen vascular disease, radiation effects, adverse medical side effects
These conditions can lead to structural changes in the mitral valve.
What congenital anomalies can result in secondary MR?
Cleft leaflet and parachute mitral valve
Both are very rare conditions.
What characterizes secondary MR?
Etiology due to ventricular dilation or segmental wall motion abnormality
This results in functional impairment rather than direct valve pathology.
What is a common ischemic cause of secondary MR?
Coronary artery disease
Particularly affects the posteroinferior left ventricular territories.
What are nonischemic causes of secondary MR?
Dilated cardiomyopathy, viral cardiomyopathy, idiopathic cardiomyopathy
These conditions can lead to annular dilatation and functional MR.
Fill in the blank: Primary MR can result from _______ changes isolated to the valvular complex.
degenerative
True or False: Atrial fibrillation can contribute to secondary MR.
True
Atrial fibrillation can lead to annular dilatation, impacting valve function.
What are the types of MR based on etiology?
Primary MR and Secondary MR
Primary MR is due to intrinsic valve issues, while secondary MR is due to ventricular dysfunction.
What causes chronic MR?
Progressive disease of the MY and/or LV
What are the typical symptoms of chronic MR at rest?
Usually none
What symptom is commonly associated with chronic MR during exercise?
Dyspnea on exertion (DOE)
What causes acute MR?
Chordae or papillary muscle rupture
What symptom is associated with acute MR at rest?
Dyspnea at rest
What severe condition may result from acute MR?
Emergent respiratory distress requiring intubation
What is a significant finding in chronic conditions related to heart function?
Significant MR
MR stands for mitral regurgitation, a condition where the heart’s mitral valve does not close tightly, allowing blood to flow backward in the heart.
Which arrhythmias are notable in chronic heart conditions?
Atrial fibrillation/flutter
Atrial fibrillation is an irregular and often rapid heart rate that can increase the risk of strokes, while atrial flutter is a similar condition but with a more organized electrical activity.
What does elevated JVP indicate in chronic conditions?
Right-sided heart failure
JVP stands for jugular venous pressure, and elevation can suggest issues with the right side of the heart.
What type of edema is associated with chronic heart conditions?
Peripheral edema (right sided)
Peripheral edema refers to swelling in the extremities, often due to fluid accumulation from heart failure.
What is a murmur?
A blowing, high pitched holo-systolic murmur heard at the apex
We do not hear small amounts of MR.
What characterizes a heart sound?
A mid-to-late systolic ‘click’ (and murmur)
Most common in mitral valve prolapse (MVP) and due to chordal tension.
True or False: A ‘click’ is a type of murmur.
False
A ‘click’ is a heart sound, not a murmur.
In which condition is a mid-to-late systolic ‘click’ most commonly heard?
Mitral valve prolapse (MVP)
The ‘click’ is due to chordal tension.
What is Transesophageal Echocardiography (TEE)?
A gold standard in the visualization of cardiac valves
TEE is an imaging technique that uses ultrasound to create detailed images of the heart’s structures.
What are the main evaluations performed using TEE?
Evaluation of valve morphology, hemodynamics, and function
TEE provides insights into the structure and performance of heart valves, including their shape and movement.
What does MVP stand for?
Mitral Valve Prolapse
Also known as Myxomatous Valve Disease.
What happens to the valve leaflets during ventricular contraction in MVP?
They bulge/bend into the left atrium
This results in leakage of blood back into the left atrium.
What is the most common cause of Mitral Valve Prolapse?
Congenital
MVP is often present from birth.
What genetic disorder is associated with MVP?
Myxomatous degeneration
This is the weakening of connective tissue.
What is the incidence of Mitral Valve Prolapse in the population?
2-5%
This indicates the percentage of individuals affected by MVP.
What are some common symptoms of Mitral Valve Prolapse?
- Chest pain
- Palpitations
- Can be asymptomatic
Palpitations are especially common among those with MVP.
True or False: Mitral Valve Prolapse can be asymptomatic.
True
Some individuals may not experience any symptoms.
Fill in the blank: Mitral Valve Prolapse is also known as _______.
Myxomatous Valve Disease
This alternative name reflects the underlying condition.
What does mild MVP demonstrate?
Slight displacement of the leaflets beyond the annular plane
MVP stands for Mitral Valve Prolapse, a condition where the leaflets of the mitral valve bulge into the left atrium during heart contraction.
What does severe MVP demonstrate?
Significant displacement of the leaflets beyond the annular plane
Severe MVP can lead to more serious symptoms and complications compared to mild MVP.
What is the general treatment approach for Mitral Valve Prolapse (MVP)?
No surgery required unless the patient becomes symptomatic
What symptoms indicate the need for surgical intervention in MVP?
Symptomatic dyspnea in the presence of significant MR, chamber dilation, and elevated PASP
What is performed to assess the severity of MR and chamber size in MVP patients?
Serial TTE
What should be prescribed if a patient with MVP is symptomatic but has no significant MR?
Beta-blockers
Fill in the blank: If a patient with MVP experiences _______ but has no significant MR, beta-blockers are prescribed.
palpitations/high HR-tachy
What is the first step in evaluating a partial flail posterior leaflet?
Evaluate leaflet thickening
This involves assessing the structural integrity of the leaflet.
What should be evaluated in relation to the closure of the valve?
Evaluate the coaptation (closure) surface line
This assesses how well the leaflets come together to prevent regurgitation.
What is critical to assess when examining the valve?
Critical to pan through the valve (RVI/RVO) to look for the flail
RVI refers to right ventricular inflow, and RVO refers to right ventricular outflow.
What condition is usually present with significant MR?
Significant MR is usually present
MR stands for mitral regurgitation.
If one leaflet is involved in MR, how is the regurgitation typically characterized?
MR most likely will be eccentric (wall hugger)
This indicates that the regurgitant jet is directed towards the wall of the heart.
What is Ischemic CM Causing Incomplete Mitral Leaflet Closure (IMLC)?
A condition where leaflets do not coapt at the annular plane, creating a ‘tenting’ effect
What is the typical measurement of the tenting effect in IMLC?
8cm
What causes IMLC?
Papillary muscle displacement due to left ventricular dilation or dysfunction
What is the limitation of the chordae in IMLC?
Chordae can only stretch so far, preventing complete closure of the valve
What is a significant consequence of IMLC?
Resulting in significant mitral regurgitation (MR)
What type of jet is usually observed in MR from IMLC?
Usually a central jet
Can MR in IMLC be eccentric?
Yes, it can be eccentric (wall hugger)
What is Mitral Annular Calcification (MAC)?
Abnormal calcification that typically develops with aging.
MAC can lead to various cardiac complications.
What effect can significant MAC have on the mitral valve leaflets?
It can encroach upon the leaflets, restricting their mobility.
This restriction can affect valve function and lead to mitral regurgitation.
What is the appearance of MAC on echocardiography?
An echo-bright structure seen at the posterior annulus.
This appearance may resemble a mitral valve repair, necessitating careful differentiation.
True or False: Mitral Regurgitation (MR) is always present with severe MAC.
False.
MR may or may not be present with severe MAC.
How does severe posterior MAC appear on imaging?
It appears as a significant echo-bright structure at the posterior annulus.
This can mimic other conditions, such as mitral valve repair.
What is the process to visualize both leaflets in a 2D assessment?
Pan until all portions of both leaflets are visualized
How many sections are there in each leaflet during a 2D assessment?
Three sections
What are the names of the sections in each leaflet?
- A1/P1 (lateral)
- A2/P2 (medial)
- A3/P3 (central)
Which section is most commonly associated with Mitral Valve Prolapse (MVP)?
P2
What percentage of MVP cases is P2 most common?
80%
What does CW stand for in CW Doppler?
Continuous Wave
CW Doppler is used in echocardiography to assess blood flow.
What is the typical duration of the MR signal in CW Doppler?
Holo/pan systolic
This duration occupies the isovolumic periods.
What should be looked for if the MR signal is observed in late systole?
Mitral Valve Prolapse (MVP)
Late systolic MR signals may indicate MVP.
What is the typical shape of the MR Doppler signal?
Symmetric (parabolic, U-shaped)
Normal MR signals tend to have a symmetric shape.
What shape of MR Doppler signal is expected in severe MR with high LAP?
Asymmetrical shape (V-shaped)
A V-shaped signal suggests more severe mitral regurgitation.
Fill in the blank: The density of the _______ MR Doppler signal is an important parameter.
CW
Continuous Wave Doppler is used to assess the density of the signal.
