MS, MR, MVP Flashcards
What is the primary cause of mitral stenosis?
Rheumatic heart disease (99%)
Commissural fusion and leaflet thickening are associated with rheumatic heart disease.
What are the secondary causes of mitral stenosis?
Congenital or carcinoid (1%)
These are less common compared to rheumatic heart disease.
What is the hallmark of mitral stenosis?
Increased LA pressure leading to LA dilation and backup of blood into the pulmonary vasculature
LA stands for left atrium.
What is exertional dyspnea in the context of mitral stenosis?
Increased LAP leads to less blood in ventricles and more blood in left atrium
This exacerbates symptoms during exertion.
What happens to pulmonary capillary wedge pressure (PCWP) in mitral stenosis?
PCWP is higher than the oncotic pressure of plasma
This leads to fluid exudation into the interstitium.
What are the symptoms of hemoptysis in mitral stenosis caused by?
Rupture of pulmonary capillaries and bronchial venous anastomosis
This can lead to coughing up blood.
What neurological symptoms can occur in mitral stenosis?
Atrial Fibrillation leading to thrombus formation and thromboembolism to the brain
This can present as TIA or stroke.
What should be administered to a mitral stenosis patient with neurological symptoms?
Warfarin + heparin until INR=2, then continue warfarin only
This is to prevent further thromboembolism.
What changes occur in the A-wave on JVP and S4 in patients with Atrial Fibrillation?
They disappear
This indicates a change in atrial pressure dynamics.
What are general symptoms of heart failure associated with mitral stenosis?
SOB, fatigue, etc.
SOB stands for shortness of breath.
What causes hoarseness in mitral stenosis patients?
LA pressing on laryngeal nerve
This pressure can lead to voice changes.
What causes dysphagia in mitral stenosis patients?
LA pressing on esophagus
This can lead to difficulty in swallowing.
What are the characteristic signs of mitral stenosis?
Loud S1, normal S2, opening snap after S2, rumbling mid-diastolic murmur
These are auscultatory findings during a physical examination.
What is the significance of the opening snap in mitral stenosis?
Sound of sudden movement of anterior mitral leaflet
This leaflet is usually less calcified than the posterior leaflet.
What happens to the anterior mitral leaflet in more severe mitral stenosis?
Heavily calcified leading to loss of opening snap
This indicates worsening stenosis.
What is presystolic accentuation in mitral stenosis?
Sound increases before S1
This is another characteristic auscultation finding.
What is mitral facies?
Malar rash/flush
This is a facial appearance associated with mitral stenosis.
What is the typical pulse characteristic in mitral stenosis?
Atrial Fibrillation common, low volume
This reflects irregular heart rhythms.
What is the apex finding in mitral stenosis?
Tapping, not displaced
This indicates the position of the heart may be affected.
What are the clinical signs of severity in mitral stenosis?
• Soft S1
• Longer duration of the murmur
• Shorter S2 - opening snap interval
These signs indicate worsening mitral stenosis.
What are the signs of left atrial enlargement seen on CXR?
• Straightening of left heart border (mitralization)
• Widened carina (>70)
• Double density shadow
• +/- Signs of pulmonary edema
• LV is normal size (no cardiomegaly)
These signs assist in diagnosing mitral stenosis.
What ECG findings indicate left atrial enlargement?
• A. Fibrillation
• P. mitrale (bifid p-wave)
P. mitrale indicates left atrial enlargement.
What are the possible ECG changes associated with pulmonary hypertension?
• P. pulmonale (Right atrial hypertrophy)
• Possibly RVH (right axis deviation, tall R waves in V1)
These changes can occur as a result of increased pressure in the pulmonary circulation.
What are the echocardiographic signs of severity in mitral stenosis?
• MV area = < 1cm² [N = 4-6cm²]
• MV index < 0.6cm²/m²
• Mean pressure gradient across MV = severe > 10 [N = 0]
These measurements help assess the severity of mitral stenosis.
What is the main indication for treatment in mitral stenosis?
The presence of symptoms
Treatment is typically guided by the severity of symptoms experienced by the patient.
What medical therapies are used for managing mitral stenosis symptoms?
• Beta blockers for heart rate control
• Loop diuretics for fluid overload + salt restriction
• Lifelong warfarin for A. Fib
These therapies help manage heart rate and fluid balance.
What should not be given to patients with mitral stenosis?
ACE inhibitors
ACE inhibitors can exacerbate heart failure in these patients.
What is the treatment of choice for severely symptomatic mitral stenosis or if pulmonary hypertension develops?
Percutaneous transseptal balloon valvotomy (TSBV)
TSBV is preferred unless contraindications like LA thrombus or significant calcification are present.
What complications can arise from mitral stenosis?
• Pulmonary hypertension
• Right sided HF (high JVP, dependent edema, tender hepatomegaly, ascites)
• Congestive heart failure
• Acute pulmonary edema
• Atrial fibrillation → sudden deterioration & systemic embolization
These complications highlight the serious nature of untreated mitral stenosis.
What is the characteristic pathology associated with mitral stenosis?
• Commissural fusion
• Leaflet thickening
• Calcified nodules
• Shortened chordae
• Fish-mouth orifice (hockey stick appearance)
These pathological changes contribute to the obstruction seen in mitral stenosis.
What are the two types of Mitral Regurgitation?
- Acute MR
- Chronic MR
What is a common cause of Acute MR related to ischemic heart disease?
Papillary muscle rupture/dysfunction
What is a potential cause of Acute MR associated with mitral valve prolapse?
Ruptured chordae
What happens to left atrial pressure in Acute MR?
Sudden rise in left atrial pressure with normal LA size
What are the consequences of Acute MR on the lungs?
Backflow into the lungs → increased pulmonary venous pressure
What symptoms can present in Acute MR due to lack of time for compensation?
- Pulmonary edema
- Cardiogenic shock
What is a common cause of Chronic MR related to mitral valve prolapse?
Myxomatous degeneration (Marfan syndrome)
What is the pathophysiology of Chronic MR regarding left atrial pressure?
Gradually increased LA pressure accommodated by LA dilation & increased LA compliance
What happens to the left ventricle in Chronic MR?
LV dilation → LV dysfunction
What is a consequence of chronic backflow into pulmonary vessels in Chronic MR?
Pulmonary hypertension
What are the initial symptoms of Chronic MR due to volume overload?
Early palpitations [especially with exertion]
What symptoms may develop as compensation fails in Chronic MR?
- Dyspnea
- Orthopnea
- PND
- Fatigue
What are the auscultation findings in Mitral Regurgitation?
- Soft S1
- Normal S2
- S3 added sound
What is the characteristic murmur associated with Mitral Regurgitation?
Pansystolic murmur (radiates to axilla)
What additional sound may be present if the cause of MR is MVP?
Mid-systolic click followed by late systolic murmur
What clinical sign may indicate pulmonary hypertension in MR?
Loud palpable P2
What are some clinical signs of severity in Mitral Regurgitation?
- Hyperdynamic apex
- S3
- Added short mid-diastolic flow murmur
- Systolic thrill (grade 4)
- Wide split S2
- Signs of pulmonary hypertension
What are the findings on a chest X-ray (CXR) for MR?
Cardiomegaly, Dilated LV, Pulmonary edema
CXR findings are important for diagnosing mitral regurgitation.
What ECG complication may develop in MR?
A. Fib
Atrial fibrillation is a common arrhythmia associated with mitral regurgitation.
What echocardiographic findings are associated with MR?
Dilated LA & LV, Decreased LV function
Echocardiography is essential for assessing the severity of mitral regurgitation.
What is the treatment for mild asymptomatic MR?
Follow-up echo and clinical examination
Regular monitoring is important in asymptomatic cases.
What medical therapies are used for MR?
ACE inhibitors, Diuretics, Warfarin if A. Fib
These medications help manage symptoms and complications of mitral regurgitation.
What is the emergency surgical treatment for acute MR?
Valve replacement
Acute mitral regurgitation requires immediate surgical intervention.
What is preferred for chronic MR: repair or replacement?
Repair
Valve repair is often better than replacement in chronic cases.
What are the indications for surgery in symptomatic MR?
Symptomatic, Severe, EF > 30%, End-diastolic diameter < 55mm
These criteria help determine when surgery is necessary.
What are the indications for surgery in asymptomatic patients with MR?
End systolic dimension > 45mm, EF < 60%, Preserved EF with A. Fib or pulmonary hypertension
These measurements indicate increased risk in asymptomatic patients.
What causes mitral valve prolapse?
Myxomatous degeneration caused by Marfan syndrome
Marfan syndrome is a connective tissue disorder associated with mitral valve prolapse.
What pathology occurs in mitral valve prolapse?
One of the mitral valve leaflets prolapses back into the LA
This can lead to mitral regurgitation in some patients.
What are common presentations of mitral valve prolapse?
Atypical chest pain, Palpitations, Mid-systolic click followed by later systolic murmur
Symptoms can vary widely among individuals.
How does the murmur intensity change from stand to squat in mitral valve prolapse?
Decreases in intensity & click increases
This change helps in the clinical assessment of the condition.
How does the murmur intensity change from squat to stand in mitral valve prolapse?
Increases in intensity & click decreases
This response is part of the physical examination findings.
What is the diagnostic tool for mitral valve prolapse?
Echocardiography
Echocardiography is crucial for confirming the diagnosis of mitral valve prolapse.
What is the treatment for chest pain and palpitations in mitral valve prolapse?
Beta-blockers
These can help alleviate symptoms associated with mitral valve prolapse.
What medication is used to prevent thromboembolism in mitral valve prolapse?
Anticoagulants
Anticoagulants are particularly important for patients at risk of thromboembolic events.
