L32

Question 1

Cause of mitral stenosis

Answer 1

Rheumatic heart disease

Question 2

Pathophys and symptoms of mitral stenosis

Answer 2

Stiff valve - less blood into LV
More pressure in the LA --> higher pulm pressures
Symptoms = CHF
- DOE
- Fatigue
- SOB
- Orthopnea/PND

Question 3

So what kind of HF does mitral stenosis cause?

Answer 3

HF w/ normal LV filling pressure

The exception to the rule since all other HFs have this

Question 4

Does the LA change size due to mitral stenosis? What do said changes increase the risk of?

Answer 4

Dilation b/c high P

Higher risk AFib

Question 5

Which ventricle is more likely to fail with mitral stenosis

Answer 5

RV

Question 6

How do these factors change throughout mitral stenosis

1. Arterial pulse
2. Apical impulse
3. JVP

Answer 6

All normal!
Until... develop pulm HTN
1. Loud P2 arterial pulse
2. RV heave
3. Large "a" wave in JV pattern

Question 7

Mitral stenosis auscultation - 3 pts

Answer 7

1. Opening snap = stiff valve opens, after S2
2. Diastolic (after S2) low pitched murmur
3. Loud S1
   “Lubb dup dup purr”

Question 8

What might be included in the diastolic mitral stenosis murmur?

Answer 8

Pre-systolic accentuation - gets louder closer to systole

Question 9

Best place to hear MS

Answer 9

L lateral decubitus

Question 10

Scan images for MS

Answer 10

LA dilated/enlarged
RV hypertrophy
**STRAIGHT heart border +/- elevated L bronchi +/- esophagus out of the way

Question 11

3 pts of mitral valve stenosis treatment

Answer 11

1. Decrease LA pressure - diuresis
2. Manage AFib
3. Meds to prevent clots

Question 12

2 surg options for MS

Answer 12

Commissurotomy

Replacement

Question 13

Primary mitral regurg

Answer 13

Pathology of valve componenets

Question 14

Secondary mitral regurg

Answer 14

1ary problem = dilated LV

2ary problem is dilation means valve won’t close correctly

Question 15

Pathophys mitral regurg

Answer 15

LV blood –> LA b/c lower P here
LV sees larger vol load b/c = diastolic filling + reflux blood from LA
Increase LV stroke volume to get the normal amt of blood into aorta while losing some to LA = DILATION

Question 16

What is EF good or bad for dilated heart under volume overload?

Answer 16

Good = high EF

Question 17

Is EF good or back for pumping if b/c of cardiomyopathy or ESRD

Answer 17

Bad pump = low EF

Question 18

LA and LV size and pressures in acute MR

Answer 18

Normal LV and LA size

High pressure in LA due to higher volume in same sized atria - P reflected in lungs

Question 19

LA and LV size and pressures for chronic MR

Answer 19

LA & LV dilated

Pressures are normal due to dilation over time to accommodate sustained pressures due high volume

Question 20

Presentation MR

Answer 20

CHF

Question 21

3 findings of MR auscultation

Answer 21

1. Holosystolic murmur = bet S2-3
2. S3
3. Palpable hyperdynamic apex

Question 22

What shows in cath lab for MR

Answer 22

V wave in cap wedge position

Question 23

Treat acute vs chronic MR

Answer 23

Acute - IV nitroprusside + intra-aortic balloon

Chronic - vasodilate PO

Question 24

2 surg options for MR

Answer 24

Repair

Replace

Question 25

Mitral prolapse pathphys

Answer 25

Less collagen/elastin
More myxomatous - looser tissue in valve
- Inherited degenertation

Question 26

What dictates the symptoms of mitral prolapse

Answer 26

Degree of associated MR

Aka common for regurg to develop 2ary

Question 27

Auscultation for mitral prolapse

Answer 27

Mid-late systolic click
Late systolic murmur
CHANGES w/ MANEUVERS

Question 28

What type of mitral prolapse do you treat?

Answer 28

Ruptured chordae -> flailing leaflet

Acute, severe