Week 5 - Valvular Heart Disease - Mitral Valve

Question 1

How are the valves positioned anatomically?

Answer 1

all on same plane. pulmonary most anterior, aortic right behind, then mitral on left and tricuspid on right, next to eachother

Question 2

What are features of the mitral valve?

Answer 2

has 2 leaflets. 4-6cm^2. chordae tendonae leave it, attach to papillary muscles which attach to ventricular wall.

Question 3

What is the aetiology of mitral stenosis?

Answer 3

most commonly rheumatoid heart disease.
Infective endocarditis
sometimes congenital

Question 4

What is the pathophysiology of mitral stenosis?

Answer 4

stenosed from 4-6cm^2 to under 2cm^2.
increased pressure gradient between LA and LV. LA hypertrophy, LV remains normal.
backflow into lungs - pulmonary hypertension. late stage - may cause right heart dilatation, tricuspid and aortic valve regurgitation.

Question 5

What are symptoms and manifestations of MS?

Answer 5

• dyspnoea,
• haemoptysis
• infected valve
• chest pain (tight)
• enlarged left atrium compresses laryngeal nerve - hoarse voice

Question 6

What may you find in a clinical examination of a Mitral Stenosis patient?

Answer 6

• tapping apex beat and diastolic thrill
• mitral facies
• atrial fibrillation

normal pulse
raised JVP
RV heave (due to hypertrophy)
auscultation lay sideways. normal 2 beats, quiet murmur after

Question 7

How do you investigate and diagnose mitral stenosis?

Answer 7

ECG.
CXR for LA hypertrophy.
Echocardiography for valve images.
CMRI for hypertrophy and valve leaflets.

Question 8

What leads to dilatation and hypertrophy of a chamber?

Answer 8

dilatation is a result of regurgitation - stretches chamber
hypertrophy is a result of stenosis - pressure means muscle has to work harder

Question 9

How do you treat mitral stenosis?

Answer 9

• anticoagulate to prevent embolism.
• diuretics for BP
• atrial fibrillation common so restore sinus rhythm.

Question 10

What is the aetiology of mitral regurgitation?

Answer 10

• rheumatic heart disease,
• degeneration with age,
• infection
• functional (LV enlarges to MV position changes)

Question 11

What is the pathophysiology of mitral regurgitation?

Answer 11

causes reduced EF and backflow of blood in LV. causes LV dilatation. leads to congestive heart disease

Question 12

What are clinical symptoms/manifestation of acute and chronic mitral regurgitation?

Answer 12

acute - act fast. breathless, pulmonary oedema, cardiogenic shock.
chronic - slowly over long time. fatigue and exhaustion due to low cardic output. tend to develop A-fib too

Question 13

What is found on clinical examination of mitral regurgitation?

Answer 13

reduced pulse,
raised JVP,
brisk apex beat,
RV heave,
auscultation reduced first heart sound as leaflets may not meet. loud at apex - radiates to axilla.

Question 14

What investigations are done to diagnose mitral regurgitation?

Answer 14

ECG - if serious tall p wave (RA enlargement)
CXR - LA enlargement
Echocardiography to see leaflets
CMR

Question 15

What treatment is given for mitral regurgitation?

Answer 15

acute - medical emergency. increase cardiac output
chronic - wait for LV enlargement, symptoms or anything we may consider requires surgery

Question 16

What causes malar flush?

Answer 16

pulmonary hypertension causes rise in CO2 and thus vasodilation

Question 17

What does a tall p wave indicate?

Answer 17

right atrial enlargement due to pulmonary hypertension.