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Cardiology > Valvular disease - Mitral regurgitation > Flashcards

Valvular disease - Mitral regurgitation Flashcards

1
Q

What is mitral regurgitation?

A

https://www.youtube.com/watch?v=nY4aaBezu9o

A disorder of the heart in which the mitral valve does not close properly when the heart pumps out blood. It is the abnormal leaking of blood backwards from the left ventricle, through the mitral valve, into the left atrium, when the left ventricle contracts, i.e. there is regurgitation of blood back into the left atrium

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2
Q

What abnormalities can cause mitral regurgitation?

A

Abnormalities of

  • Valve leaflets
  • The annulus
  • Chordae tendineae
  • Papillary muscles
  • Left ventricle
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3
Q

Why does blood regurgitate backwards into the atrium?

A

Due to left atrial pressure being significantly lower than aortic pressure, blood regurgitates through the insufficient valve immediately after the start of ventricular contraction. By the time the aortic valve has opened, the almost a quarter of the SV may have entered the LA.

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4
Q

What happens to the left atrium due to chronic regurgitation?

A

Left atrial dilatation

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5
Q

What happens to the left atrium due to acute regurgitation?

A

The normal compliance of the left atrium does not allow much dilatation and the left atrial pressure rises. Thus, in acute mitral regurgitation the left atrial v-wave is greatly increased and pulmonary venous pressure rises to produce pulmonary oedema

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6
Q

In acute MR, what happens to preload?

A

Increased preload

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7
Q

In acute MR, what happens to afterload?

A

Decreased afterload

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8
Q

What happens to EDV in acute MR?

A

Increased EDV

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9
Q

What happens to ESV in acute MR?

A

Decreased ESV

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10
Q

What happens in response to decreased ESV in acute MR?

A

LV attempts to contract harder to eject as much blood as possible. This leads to further increased atrial pressure, which causes back pressure into the lungs, leading to PHT and pulmonary oedema

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11
Q

Why is left atrial pressure often normal in chronic compensated MR?

A

The left atrium has time to accomodate and dilate in repsonse to regurgitant volume

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12
Q

What type of LV hypertrophy develops in MR?

A

Eccentric hypertrophy

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13
Q

Why does MR worsen with LV hypertrophy?

A

The mitral annulus may stretch and prevent the mitral valve leaflets from closing properly during systole, thus worsening the MR and LV dilatation.

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14
Q

What is cardiogenic shock?

A

https://www.youtube.com/watch?v=1Gw0coR2Svo

A life-threatening medical condition resulting from an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectivelyAs this is a type of circulatory shock, there is insufficient perfusion of tissue to meet the demands for oxygen and nutrients. Cardiogenic shock is a condition that is difficult to fully reverse even with an early diagnosis, and as such is quite often fatal

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15
Q

What happens in chronic uncompensated MR?

A

In this phase, muscle dysfunction has developed. This results in a higher ESV and EDV, which in turn causes an elevation of LV and LA pressure, ultimately leading to pulmonary oedema and, if left untreated, cardiogenic shock

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16
Q

What are symptoms of acute MR?

A
  • Acute breathlessness
  • Symptoms of pulmonary oedema
17
Q

What signs might you see in someone with acute MR?

A
  • Pulmonary oedema
  • Tachycardia
  • Hypotension
  • Peripheral vasoconstriction
  • Pan-systolic murmur of MR
  • Signs of RHF
  • Cardiogenic shock
18
Q

What are causes of acute MR?

A
  • Infective endocarditis
  • Papillary muscle dysfunction/rupture
  • Rupture of chordae tendinae - infection, myxomatous degeneration
  • Trauma
  • Prosthetic valve malfunction
  • Left atrial myxoma
  • Acute rheumatic fever
  • Marfan’s syndrome
19
Q

What is an important differential to exclude if someone comes in with acute pulmonary oedema, other than acute MR?

A

VSD

20
Q

What symptoms might you find in chronic MR?

A
  • Dyspnoea
  • Fatigue
  • Palpitations - due to Afib
21
Q

What signs might you see in someone with chronic MR?

A
  • Displaced, hyperdynamic apex
  • Soft S1
  • S3
  • Sign of PHT - Split S2, Loud P2, RV heave
  • Pansystolic murmur at apex, radiating to axilla
  • Signs of HF
22
Q

Why might there be a displaced, hyperdynamic apex in MR?

A

Due to the eccentric hypertrophy that occurs due to mitral regurgitaiton

23
Q

Why can the S1 heart sound become softer?

A

Owing to the incomplete apposition of the valve cusps and their partial closure by the time ventricular systole begins

24
Q

Why is the murmur heard in MR pansystolic?

A

Owing to the occurrence of regurgitation throughout the whole of systole, being loudest at the apex but radiating widely over the precordium and into the axilla

25
Q

What is a mid systolic click caused by in MR?

A

Produced by the sudden prolapse of the valve and the tensing of the chordae tendineae that occurs during systole.

26
Q

What causes an S3 heart sound in MR?

A

Owing to the sudden rush of blood back into the dilated left ventricle in early diastole

27
Q

What are signs of PHT?

A
  • Loud P2
  • Split S2
  • RV Heave
28
Q

What investigations would you do in someone with Mitral regurgitation?

A
  • ECG
  • CXR
  • Echo
  • Cardiac MRI
29
Q

What might you see on an ECG in someone with mitral regurgitation?

A
  • AF +/- P mitrale - bifid p waves
  • Signs of LVH - Left axis deviation, increased R wave height in left lateral leads (I and V6), deep S waves in right precordial (V1 and V2)
30
Q

What might you see on CXR in Mitral regurgitation?

A
  • Left atrial and left ventricular enlargement
  • Valve calcification
  • Pulmonary oedema
31
Q

What might you see on ECHO of someone with MR?

A
  • Dilated left atrium and left ventricle
  • Chordal or papillary muscle rupture
  • Severity of regurgitation - regurgitant fraction, volume or orifice area.
32
Q

How would you manage someone with asymptomatic chronic MR?

A

Conservative, unless LV dysfunction, in which case:

  • ACEi
  • B-blockers
33
Q

When is surgical intervention recommended in MR?

A
  • Symptomatic severe mitral regurgitation
  • Left ventricular ejection fraction >30%
  • End-diastolic dimension of under 55 mm
  • Asymptomatic patients with left ventricular dysfunction
34
Q

When would emergency MR replacement?

A

Chordal or papillary muscle rupture or infective endocarditis

35
Q

How would you treat acute MR?

A
  • EMERGENCY SURGERY
  • Diuretics prior to surgery
36
Q

How would you medically treat someone with symptomatic chronic MR?

A
  • B-blockers
  • ACEi
  • Diuretics

Surgery is the option of choice

37
Q

What are the causes of Mitral Valve prolapse?

A
  • Leaflet
  • Idiopathic
  • ASD
  • PDA
  • Cardiomyopathy
  • Turner’s syndrome
  • Marfan’s syndrome
  • Osteogenesis Imperfecta
  • WPW
38
Q

What are complications of MV prolapse?

A
  • MR
  • Cerebral emboli
  • Arrhythmias
  • Sudden death

Cardiology (29 decks)

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