Valve Disorders, Mitral Stenosis + Regurg

Question 1

What does regurgitation cause?

Answer 1

Causes insufficiency + proximal chamber dilation
(Regurgitation = defective valve, floppy, doesn’t close properly)
Loss of structural chamber integrity + strength

Question 2

What does stenosis cause?

Answer 2

Causes increased upstream pressure + proximal chamber dilation + hypertrophy (stenotic = narrowed valve lumen , doesn’t fully open, stiff)
Heart becomes huge + rigid; poorly compliant

Question 3

What are the main 4 valve disorders ?
What do these cause?

Answer 3

Aortic regurgitation + stenosis
Mitral regurgitation + stenosis
Murmurs

Question 4

Murmurs best heard using what acronym?

Answer 4

RILE
Right side defects eg. Pul/tricuspid valve heard on inspiration

Left side defects eg. Aortic/mitral valve heard on expiration

Question 5

Definition of mitral stenosis

Answer 5

Mitral bicuspid lumen 4-6cm2
Mitral valve narrows
Sx at <2cm2

Question 6

MS
Typical patient?

Answer 6

Men
History of rheumatic fever/ageing

Question 7

Causes of Mitral stenosis

Answer 7

Rheumatic heart disease (MC) - post strep pyogenes infection
Valve calcification (older Px)
Infective endocarditis (<10% all causes)

Question 8

Pathology of Mitral stenosis

Answer 8

RHD causes mitral valve reactive inflammation, over years exacerbated with calcification
LA hypertrophy and chamber dilation

Question 9

Symptoms of Mitral stenosis

Answer 9

Malar cheek flush (flushing of cheeks due to high CO2 + vasodilation)
associated with Atrial fibrillation (due to LA struggling to push blood through valve and LA hypertrophy - disrupting electrical signals , causing dyspnoea (laboured breathing) as blood backs up in lungs)

A wave on JVP

Question 10

What type of murmur is seen in mitral stenosis?

Answer 10

Low pitched, Mid diastolic murmur (rumbling) - loudest at apex

loud S1 snap due to thickened valve cusps slapping each other
Closer to S2 if murmur more severe

Best heard on expiration with patient lying on LHS

Question 11

Diagnosis of mitral stenosis
Tests and results?

Answer 11

Chest X ray = LA enlarged
ECG = Atrial fibrillation, p Mitrale = bifid ‘m’ shape P waves when LA enlarged
GS - ECHO = access valve area, gradient mobility

Question 12

Treatment for Mitral stenosis

Answer 12

Surgical

Percutaneous balloon valvotomy (stent opening mitral valve opening)

Mitral valve replacement

Question 13

What is mitral regurgitation?

Answer 13

Incompetent mitral valve
Allows blood to flow back through valve during systole (from LV to LA)

Question 14

what causes Mitral regurgitation?

Answer 14

Myxomatous Mitral valve - weakened connective tissue (MC - mass of cells in valve conn tissue make leaflets heavier and prolapse)

Connective tissue disorder - Marfans, Ehlers danlos syndrome

Question 15

What does a typical Px look like?

Answer 15

female, older, low BMI, prior MI or conn tissue disorder

Question 16

Symptoms of mitral regurgitation?

Answer 16

Exertional dyspnoea (due to pulmonary hypertension, from backlog of blood)

Question 17

What type of murmur is seen in mitral regurgitation?

Answer 17

Pan systolic blowing murmur radiating to axilla at Apex

soft s1, prominent s3 in heart failure (severe cases)

Question 18

Diagnosis of Mitral regurgitation?

Answer 18

ECG = may show LA enlargement, AF and LV hypertrophy
Chest X ray
GS - ECHO = LA size & LV function analysis

Question 19

Treatment for Mitral regurgitation?

Answer 19

ACE-I, BB + several ECHO monitoring

If severe Sx at rest = valve repair/replaced