Sketchy Path: Mitral Valve Regurgitation and Mitral Valve Prolapse

Question 1

_____________ is the number one cause of mitral regurgitation.

Answer 1

Mitral valve prolapse (like the jester riding the parasail that is bulging upward)

Question 2

The most common cause of mitral valve prolapse is ______________.

Answer 2

myxomatous degeneration of the connective tissue in the mitral valve (like the MiXer that is propelling the parasailing jester)

Question 3

In addition to stretching valve leaflets, myxomatous degeneration can also cause ______________.

Answer 3

stretching and rupture of the chordae tendonae (like the other parasailing jester with the mixer who has broken parachute cords)

Question 4

Infective endocarditis can cause what mitral valve pathology?

Answer 4

Ruptured chordae tendonae (like the jester stuck in the tree with the broken cords who is lighting the lantern that represents endocarditis)

Question 5

How does acute mitral regurgitation affect cardiac output?

Answer 5

It acutely decreases CO (like the jester who can’t get his heart flashlight working).

Question 6

Mitral regurgitation causes increased ______-load for the LV.

Answer 6

pre (like the jester pulling his friend out of the water)

Question 7

Mitral regurgitation can result in what lung pathology?

Answer 7

Pulmonary venous congestion (like the unconscious jester’s wet life preserver)

Question 8

What happens to afterload in acute mitral regurgitation?

Answer 8

It decreases due to decreased CO (like the jester pushing the rock off the cliff –his afterload is falling).

Question 9

True or false: acute mitral regurgitation causes decreased ejection fraction.

Answer 9

False. Because of the increased preload, the LV actually expels more of its EDV. The difference is that some of the blood gets pumped back into the LA.

(Think of the jester flying the fraction-evoking glider.)

Question 10

List some of the other causes of primary mitral regurgitation.

Answer 10

• Chronic rheumatic heart disease (jester eating pie)
• Infective endocarditis (jester with heart lantern who has vegetations growing on his clothes from being lost in the woods)

Question 11

List some of the other causes of secondary mitral regurgitation.

Answer 11

• DCM (like the dilated hot air balloon with the rim of the basket being pulled open by the jester)

Question 12

Why doesn’t chronic mitral regurgitation cause pulmonary symptoms?

Answer 12

With a gradual progression, the left atrium has time to adapt and can accommodate the extra preload.

(Think of the hot air balloon with the grandfather clock in it –for chronicity –with the hypertrophied left portion.)

Question 13

What happens to cardiac output during chronic mitral regurgitation?

Answer 13

It is preserved by increased EF (like the pie fraction being elevated in the air).

Question 14

If mitral regurgitation persists for too long, the LV can undergo ________________.

Answer 14

eccentric hypertrophy (like the dilated ribbons around the hot air balloons)

Question 15

What murmur is common in mitral regurgitation?

Answer 15

Holosystolic murmur that radiates to the axilla (like the jester with the systolic spray with the other jester under his armpit)

Question 16

Giving _____________ can often stop the mitral regurgitation in functional mitral regurgitation.

Answer 16

diuretics (like the jester peeing on himself and taking off his cap)

Question 17

The myxomatous degeneration that leads to mitral valve prolapse can be caused by what genetic disorders?

Answer 17

• Marfans (Marfan Martian on the paraglider)
• Ehlers-Danlos
• Osteogenesis imperfecta

Question 18

What ways can you alter the murmur heard in mitral valve prolapse?

Answer 18

• Decreasing preload –such as with Valsalva or tachycardia –moves the click closer to S1 (like how the guy holding his breath is closer to the S1 post)
• Increasing preload –such as by squatting or the leg raise –causes the click to move closer to S2 (like how the one guy raising his legs and the other guy squatting are both closer to the S2 post)