MR FULL Flashcards
What is Primary MR?
Degenerative; etiology that affects only the valvular components
What are the myxomatous changes associated with mitral valve degeneration?
Prolapse (most common), flail, ruptured or elongated chordae
What are some degenerative changes that can occur in mitral regurgitation?
Calcification, thickening of valve components
What infectious condition can lead to mitral regurgitation?
Endocarditis resulting in destructive vegetations, leaflet perforation or aneurysm
What are some inflammatory causes of mitral regurgitation?
Rheumatic, collagen vascular disease, radiation, adverse medical side effects
What are some congenital causes of mitral regurgitation?
Cleft leaflet, parachute MV (both very rare)
What is Secondary MR?
Functional, MR that occurs due to ventricular dilation or segmental wall motion abnormality
What is an ischemic cause of secondary mitral regurgitation?
coronary artery disease, especially posteroinferior LV territories
What are some nonischemic causes of secondary mitral regurgitation?
Dilated, viral or idiopathic cardiomyopathy, annular dilatation, atrial fibrillation, restrictive cardiomyopathy
What is chronic MR caused by?
Progressive disease of the MV and/or LV
What are the typical symptoms of chronic MR at rest?
Usually none
What is a common symptom of 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 can acute MR result in that may require intubation?
Emergent respiratory distress
Fill in the blank: Dyspnea on exertion is also known as _______.
DOE
What does elevated JVP indicate?
Right sided heart issues
JVP stands for jugular venous pressure and is a measure of the pressure in the right atrium.
What is peripheral edema associated with?
Right sided heart failure
Peripheral edema refers to swelling in the lower extremities due to fluid accumulation.
What is a murmur?
Blowing, high pitched holo-systolic murmur heard at the apex
We do not hear small amounts of MR.
In which condition is a mid-to-late systolic ‘click’ most commonly heard?
Mitral valve prolapse (MVP)
Due to chordal tension.
True or False: A ‘click’ is classified as a murmur.
False
A ‘click’ is a heart sound.
What is the gold standard in the visualization of cardiac valves?
Transesophageal Echocardiography (TEE)
What aspects of cardiac valves can TEE evaluate?
Morphology, hemodynamics, and function
True or False: TEE uses sound waves for imaging.
True
What are the characteristics of MV morphology in moderate MR?
Moderate leaflet abnormality or moderate tenting
What are the severe valve lesions in severe MR?
Primary: flail leaflet, ruptured papillary muscle, severe retraction, large perforation; Secondary: severe tenting, poor leaflet coaptation
What is the size of LV and LA in mild MR?
Usually normal
What is the size of LV and LA in moderate MR?
Normal or mild dilated
What is the size of LV and LA in severe MR?
Dilated
What are the types of abnormalities associated with mild MR?
Calcifications or prolapse, mild tenting
What is included in the apparatus?
Papillary muscle, Chordae tendineae, Both leaflets, Annulus
These components are essential for the functioning of the heart valves.
What is the function of the papillary muscle?
To anchor the chordae tendineae and help control the opening and closing of heart valves
Papillary muscles contract to prevent the inversion of the valves during ventricular contraction.
What are chordae tendineae?
Thin, fibrous cords that connect the papillary muscles to the heart valves
They play a crucial role in preventing the prolapse of the valves.
What is the role of the leaflets in the heart?
To open and close to regulate blood flow through the heart
Leaflets are part of the heart valves, ensuring unidirectional blood flow.
What is the annulus in the context of heart anatomy?
A fibrous ring that supports the heart valves
The annulus provides structure and stability to the valve leaflets.
What is Mitral Valve Prolapse (MVP)?
Valve leaflets bulge/bend into LA during ventricular contraction, resulting in leakage of blood back into LA
MVP is also known as Myxomatous Valve Disease.
What is the most common form of Mitral Valve Prolapse?
Congenital
Congenital MVP is present at birth.
What genetic disorder is associated with Mitral Valve Prolapse?
Myxomatous degeneration
Myxomatous degeneration involves the weakening of connective tissue.
What is the incidence of Mitral Valve Prolapse in the population?
2-5%
This indicates that MVP affects a significant portion of the population.
List three common symptoms of Mitral Valve Prolapse.
- Chest pain
- Palpitations
- Can be asymptomatic
Many individuals with MVP may not experience any symptoms.
What heart sound may indicate MVP?
Systolic murmur and/or “click” heart sound
When are the murmur and click heard in MVP?
In late-systole if regurgitation is present
What is observed in the mitral valve leaflets during MVP?
One or both MV leaflets displace upwards beyond the annular plane into the LA
What is the term used for the upward displacement of valve leaflets in MVP?
Superior systolic displacement
What is the relationship between leaflet displacement and MVP severity?
The further the leaflets displace, the more severe the MVP
What symptoms may indicate the need for surgical intervention in MVP?
Dyspnea in the presence of significant MR, chamber dilation, and elevated PASP
What should be prescribed if a patient with MVP is symptomatic but has no significant MR?
Beta-blockers
What is the effect of beta-blockers in MVP treatment?
Slows HR
What is Incomplete Mitral Leaflet Closure (IMLC)?
Leaflets do not coapt at the annular plane creating a ‘tenting’ effect
IMLC is a condition where the mitral leaflets fail to close properly.
What causes the ‘tenting’ effect in IMLC?
Papillary muscle displacement due to left ventricular dilation or dysfunction
This displacement affects the normal function of the mitral valve.
What does MAC stand for?
Mitral Annular Calcification
What can significant Mitral Annular Calcification encroach upon?
The leaflets, restricting mobility
What does significant MAC appear as on an echocardiogram?
An echo-bright structure seen at the posterior annulus
True or False: Mitral Regurgitation may or may not be present with MAC.
True
What are the names of the three sections of each leaflet?
- A1/P1 (lateral)
- A2/P2 (medial)
- A3/P3 (central)
Which section is most common in MVP?
P2 is most common in MVP (80%)
Fill in the blank: A2/P2 is located in the _______ section of the MV leaflets.
[medial]
What is Vena Contracta (VC)?
Narrowest portion of a jet that occurs at or just downstream from the orifice
Vena Contracta is a key concept in fluid dynamics, particularly in the study of jet flows.
Where is the cross-sectional dimension of the Vena Contracta measured?
At or just downstream from the orifice
This measurement is crucial for understanding the flow characteristics at the orifice.
What type of flow is associated with Vena Contracta?
High velocity laminar flow
Laminar flow refers to a smooth, orderly flow of fluid, as opposed to turbulent flow.
What is the classification for mild Vena Contracta?
< 0.3
This classification indicates a low level of constriction in the jet flow.
What is the classification for moderate Vena Contracta?
0.3 - 0.69
This classification indicates a medium level of constriction in the jet flow.
What is the classification for severe Vena Contracta?
0.70
This classification indicates a high level of constriction in the jet flow.
What happens to the IAS in significant MR due to elevated filling pressures?
IAS bends away from regurge
This is indicative of increased left atrial pressure.
What is the mitral E wave velocity that is consistent with severe MR in the absence of severe diastolic dysfunction?
Mitral E wave velocity > 1.2 - 1.5 m/sec
This measurement helps in assessing the severity of mitral regurgitation.
What must be ruled out when diagnosing severe MR?
Co-existing stenosis
It is important to differentiate MR from mitral stenosis for accurate diagnosis.
What characterizes the E wave and A wave in severe MR?
Very large E wave & Small A wave
This reflects the hemodynamic changes occurring in severe mitral regurgitation.
What does the EROA stand for in the context of chronic MR assessment?
Effective Regurgitant Orifice Area
True or False: The RF percentage may be lower in secondary MR with elliptical ROA.
True
In low flow conditions, what can happen to the RF percentage?
It may be lower
Fill in the blank: The RVol for severe MR is _______.
≥ 45 mL
Fill in the blank: The RF percentage for moderate MR is _______.
30-39%
What are the three types of assessments for grading the severity of MR?
Qualitative, Semi-Quantitative, Quantitative
These categories reflect different methodologies used in evaluating mitral regurgitation.
Name a semi-quantitative method used in MR assessment.
Doppler (CW), Regurgitation Jet Area
Continuous Wave (CW) Doppler is frequently utilized to estimate the severity of MR.
What are two quantitative methods for grading MR severity?
Vena Contracta, PISA/Flow Rate
Vena Contracta measures the narrowest part of the regurgitant jet, while PISA (Proximal Isovelocity Surface Area) assesses flow rate.
What does RV represent in the assessment of MR?
Regurgitant volume (ml/beat)
RV indicates the amount of blood that regurgitates back into the heart during each heartbeat.
What is the meaning of RF in MR assessment?
Regurgitant fraction (%)
RF is the percentage of the total stroke volume that is regurgitant.
What does EROA stand for?
Effective regurgitant orifice area (cm2)
EROA measures the size of the orifice through which blood regurgitates.
What is the formula for flow rate in cc/sec?
2 x π x r² x V1
Flow rate is calculated using the radius and velocity.
What does ERO stand for in the context of quantitative formulas?
Effective Regurgitant Orifice (ERO) cm²
ERO is a measure used in evaluating mitral regurgitation.
How is Regurgitant Volume (RV) calculated?
ERO x VTI(MR)
VT|MR refers to the time velocity integral of mitral regurgitation.
What variable does V2 represent in the context of flow rate?
MR peak velocity in cm/sec
MR stands for mitral regurgitation.
Fill in the blank: Flow rate is calculated using the formula _______.
2 x π x r² x V1
True or False: Regurgitant Volume can be calculated using the formula ERO x VT|MR.
True
What type of flow is associated with high velocity in Vena Contracta?
Laminar flow
Laminar flow is characterized by smooth, orderly fluid motion.
What VC value is considered mild?
VC < 0.3
Mild conditions indicate less than significant constriction in flow.
What VC value range is classified as moderate?
VC 0.3 - 0.69
Moderate conditions suggest a noticeable effect on flow.
What VC value is classified as severe?
VC > 0.70
Severe conditions indicate a significant constriction affecting the flow.
What are the categories for grading the severity of Chronic MR?
Mild, Moderate, Severe
What is the Rvol (mL) threshold for Severe Chronic MR?
≥ 60
Fill in the blank: The RF (%) threshold for Moderate Chronic MR is _______.
30 - 39
What RF (%) corresponds to Moderate/Severe Chronic MR?
30 - 49
What is the EROA range for Mild Chronic MR?
< 0.20
What is the radius in cm for Moderate Chronic MR?
0.9
True or False: An EROA of 0.20 - 0.29 indicates Mild Chronic MR.
False
Values for severity of EROA
<0.20, 0.20-0.29, 0.30-0.39, >0.40
Values of RVOL severity
<30, 30-44, 45-59, >60
Values of RF severity
<30, 30-39, 40-49, >50
Values for VC severity in MR
<0.3, 0.3-0.69, >0.7
