Valvular heart disease - Mitral Flashcards
What valve is made up only of two leaflets
Mitral valve
What is the AV valves strongly connected too
The left ventricle though the papillary muscle
What is the aetiology of mitral stenosis
Rheumatic Heart Disease - most common
Congenital MS (born with it) - rare
Systemic lupus erythematosus - autoimmune disease that affects the healthy tissue
Infective endocarditis
When would you call it mitral valve stenosis
When the mitral valve is less than 2cm
What is the normal span for a mitral valve
4-6cm
What is the pathophysiology occurring when the mitral valve narrows and causes pulmonary hypertension
The pressure gradient between the atrium and the vertical increases,
left atrium build up backtracks to pulmonary circulation to the right side of the heart creating pulmonary hypertension
resulting in right heart dilation
What heart chamber suffers in mitral stenosis
Left atrium
What affect does mitral stenosis have on the left ventricle
Left ventricle pressure and systolic function normally
What affects the severity of mitral stenosis
Transvalvular pressure gradient and flow rate
What condition branching of mitral stenosis make it easier to clingy diagnose mitral stenosis
When tachycardia occurs as other signs and symptoms accompany
What is the symptoms of mitral stenosis
Dyspnoea: Haemoptisis Chest pain Hoarseness palpitations
What causes the dyspnoea in mitral stenosis
Pulmonary oedema - accumulation of blood
What causes haemoptisis in mitral stenosis
rupture of thin-walled veins due to increased pressure
What causes hoarseness in mitral stenosis
Left atrium enlarges so much that is compresses the recurrent laryngeal nerve
What causes the systemic embolisation in mitral stenosis
Left atrium enlargement
What is the clinical signs in mitral stenosis examination
Mitral facies - discolouration of nose and cheeks Pulse – normal JVP – prominent a wave Tapping apex beat and diastolic thrill RV heave
Auscultation:
Diastole murmurs (blow)
S3
Why is the pulse normal in mitral stenosis
As the left ventricle is normal
Why is the a wave more prominent in JVP
as pressure is higher on the right side of the heart
What is signs the mitral stenosis is severe
A longer right ventricle heave
Loud murmur
Why can you hear a third heart sound in mitral stenosis auscultation
mitral valve opening because of the pressure
What investigations are used for mitral stenosis
ECG catheritisation Chest x ray Cardiac Magnetic Resonance Echocardiography
On a ECG how do you measure mitral stenosis severity
Greater P wave or R wave on an ECG the greater the atrial ventricular gradient and severity
What does a chest x ray show
If there if a left atrium enlargement
What is best used for diagnosis of mitral stenosis
Echocardiography
What does a Echocardiography allow you to see in diagnosis of MS
Thickening and scarring of the leaflets
Fusion of the commissures (valves)
the difference in rest and exercise
What does cardiac magnetic resonance show in mitral stenosis investigations
Shows pressure gradient
Shows if valve is open or not
What is the medical treatment of mitral stenosis
Diuretics
restriction of Na intake
Valvotomy (balloon vs surgical)
Mitral valve replacement/repair
What medical treatment treats atrial fibrillation in mitral stenosis
anticoagulation
What is the aetiology of Mitral Regurgitation
Rheumatic Heart Disease Mitral valve prolapse (MVP) Infective endocarditis Degenerative LV and annular dilatation
What occurs in mitral valve prolapse
Occurs later in life in middle aged men, chordae tendinae snap, valves no longer anchored so parachute upwards - therefore leak
What occurs in degenerative heart disease
Tissue become thicker due to slow calcification of mitral valves - become fibrotic
What can potentially cause left ventricle enlargement
Previous heart attack
What is the affect of left ventricular enlargement on the mitral valve
Stretches the two cusps of the mitral valve apart
What is effective regurgitant orrifice of mitral regurgitation dependant upon
(the leakiness of the valves)
Preload,
After-load,
Left ventricle contractility
Why doesn’t ventricular compensation occur in acute mitral regurgitation and therefore what happens
Ventricles struggle to adapt as chordae has just snapped
and no mechanism has been put in place
end-systolic pressure and end-systolic volume decreases which in turn decreases wall tension
What occurs as a result of left ventricular compensation in chronic mitral regurgitation
The ventricles adapt to pressure and volume changes and usually contract more forcefully and dilate
therefore increasing end diastolic volume allowing room for extra volume and pressure as compensation to MR
What is the symptoms of mitral regurgitation
Dysnopea
Fatigue
What is the clinical manifestations of acute and chronic mitral regurgitation
acute
Pulmonary oedema
cardiogenic shock
Chronic Ventricle dilation Right heart failure Atrial fibrillation Pulmonary hypertension
Whats is the pathophysiology in left atrium compliance in mitral stenosis
Thickening of atrial myocardium increase pulmonary Ventricular Resistance resulting in pulmonary hypertension
Increase in volume mean less changes in pulmonary vasculature leading on to the development of atrial fibrillation
What can be found on clinical signs and symptoms of mitral regurgitation
Pulse – normal
Brisk and hyperdynamic apex beat
RV heave
palpitations
Auscultation:
-loud systolic murmur
What is the signs of right heart failure due to mitral regurgitation
Prominent JVP
Reduced pulse rate
What clinical investigations take place for mitral regurgitation diagnosis
ECG CXR Cardiac catherisation echocardiography Cardiac magnetic resonance
What does ECG show in mitral regurgitation
will show enlargement of the right atria/ventricle
– bigger P wave/more prominent R wave
What does a CXR show in mitral regurgitation
will show abnormal enlargement of the heart /LA enlargement/calcification
What does a cardiac catherisation show in mitral regurgitation
LV angiography
What does a echocardiography show in mitral regurgitation
Left ventricle dimensions shows leaflet dysfunction ventricle compensation (contractility ) chordae/ papillary muscle dysfunction shows annular disease Basically shows severity of MR
What does cardiac magnetic resonance show in mitral regurgitation
shows the cardiac volumes hence gives indication of ventricle compensation due to mitral regurgitation
What is the medical treatment for acute mitral regurgitation, what is the outcome of this treatment
give patients diuretics and vasodilator
reduce preload/afterload and increase contraction of ventricle
What is the medical treatment of chronic mitral regurgitation
Diuretics
Aim to conserve valve
What surgical treatment can be performed on mitral regurgatation
Repair or replacement
What is mitral annulus
a fibrous ring that is attached to the mitral valve leaflets.
What does annular dilation result in
Annular dilatation can result in poor leaflet apposition, leading to functional mitral regurgitation.
When is surgery recommended in mitral stenosis
when MVA and ECHOs <1.5cm
What is severe MR in ECHO characterised by
systolic blood flow reversal in pulmonary veins
What is the clinical manifestations of mitral stenosis
Right heart dilation:
Pulmonary hypertension
Left atrium enlargement
atrial fibrillation
Infectious endocardtits (more prone to infection)
Systemic embolisation
Pulmonary oedema
