Mitral regurgitation

Question 1

How is it defined

Answer 1

Weakening of the connective tissue in the mitral valve which prevents it from staying closed during ventricular contraction- causes blood to flow back into LA

Question 2

Causes

Answer 2

MITRAL PROLAPSE:
Myomatous degeneration: weakening of the connective tissue at the annulus
stretched chordae tendinae
can no longer hold the valve shut
RHEUMATIC HEART DISEASE:
chronic inflammation= fibrosis of leaflet= no seal
WEAKING OF PAP MUSCLES
can no longer hold the chordae tendinae in place
LV FAILURE
dilation of LV so annulus wider
IE

Question 3

Investigations

Answer 3

1- CXR- shows cardiomegaly, calcification of valve, LA enlargement
2-ECG
3-CARDIAC CATHERISATION

Question 4

Signs

Answer 4

1-Murmurs:
Pansystolic murmur
2- JVP prominent in RH failure 
3-hyperdynamic apex beat
4-RV hypertrophy

Question 5

Symptoms

Answer 5

If acute:
SOB due to pulmonary oedema 
if chronic:
Fatigue
Palpitations 
Right heart failure

Question 6

Treatment

Answer 6

mitral valve replacement
valvotomy
TAVI
For acute MR: medication for the reduction of preload and afterload

Question 7

what happen to EDV and ESV in acute and chronic

Answer 7

In acute: 
-ESV and EDV decrease
-Wall tension decreases 
In chronic :
-EDV decrease
-ESV returns to normal

Question 8

Explain the differences in the murmur when squatting and standing

Answer 8

When squatting: 
increased VR
Leaflet area increases 
valve regurgitates later and murmur is later 
When standing
-VR not as great
-leaflet area not as expanded 
-valve regurgitation is earlier

Question 9

When do you get a hyper dynamic apex beat?

Answer 9

Not much hypertrophy in LV

Question 10

What happens to LA compliance

Answer 10

Chronic

• It increases
• Means the atrium can receive more blood at a lower pressure
• prevents the pressure In the atria from becoming greater than the ventricles
• can lead to AF due to dilation of the cells

Other:
-Can decrease due to thickening of the myocardium