18 - Valvular Heart Disease 2

Question 1

causes of mitral insufficiency

Answer 1

muscular - acute MI, trauma
connective tissue - chordal rupture (Marfan’s, prolapse), annular disruption or dilation due to LV dilation
leaflets - perforation, vegetations (endocarditis), prolapse (myxomatous degen), post inflam scarring (rheumatic)

Question 2

mitral insufficiency murmur

Answer 2

mid systolic click then a mid-late systolic murmur

severe - holosystolic, S3

Question 3

does mitral insufficiency murmur get louder or softer w/ standing?

Answer 3

louder

Question 4

only 2 murmurs that increase w/ standing and how do you distinguish

Answer 4

hypertrophic cardiomyopathy w/ outflow obstruction
mitral insufficiency
hand grip exercise - HCM softer, MVP louder

Question 5

clinical course of chronic mitral insufficiency

Answer 5

progressive leak
gradual LV volume overload
Afib
progressive CHF

Question 6

tx for mitral insufficiency

Answer 6

drugs to reduce CHF sx - diuretics and vasodilators

surgery - definitive tx (done earlier > better survival)

Question 7

MCC mitral insufficiency

Answer 7

mitral valve prolapse

Question 8

causes of mitral stenosis

Answer 8

true valvular stenosis - post inflammatory (rheumatic heart dz)
pseudo stenosis due to tumors, thrombi, vegetations

Question 9

pathophys of mitral stenosis

Answer 9

some part of valve apparatus scarred > LV preload reduced > inc LA pressures cause pulm edema > a fib from enlargement > diastolic rumble

Question 10

mitral stenosis murmur

Answer 10

diastolic rumble with presystolic accentuation

may have opening snap

Question 11

clinical presentation of mitral stenosis

Answer 11

pulm congestion/edema, pulm HTN, RV hypertrophy, low CO

dyspnea, fatigue

Question 12

tx of mitral stenosis

Answer 12

reduce HR to increase LV filling time
anticoag for afib
relieve obstruction (balloon valvulotomy or surgery)