CVPR 04-02-14 11am-Noon Mitral & Tricuspid Valve Disease - Dorosz Flashcards Preview

► Med Misc 16 > CVPR 04-02-14 11am-Noon Mitral & Tricuspid Valve Disease - Dorosz > Flashcards

Flashcards in CVPR 04-02-14 11am-Noon Mitral & Tricuspid Valve Disease - Dorosz Deck (28):
1

Mitral & tricuspid valve – timing of opening

Open in diastole (to allow blood to flow into ventricles from atria)

2

Valve diseases

Regurgitation/insufficiency (valve stays a bit open when it’s not supposed to, allowing blood flow backwards) OR Stenosis (valve won’t open enough, not allowing blood to flow forward)….. May be aortic, pulmonic, tricuspid, mitral

3

Mitral valve anatomy - parts

Annulus ….. Leaflets…. Papillary muscles…. Chordae tendonae

4

Mitral valve annulus

Fibrous ring structure that supports the valve in the atrial ventricular grove…. Not planar (Hyperbolic paraboloid – saddle-shaped for efficiency & preserved throughout species)

5

Mitral valve leaflest

Posterior = smaller but more connected to annulus… Anterior = larger

6

Mitral valve pathology

Regurgitation/insufficiency OR Stenosis

7

Primary mitral valve disease (regurgitation) – causes

Myxomatous mitral valve disease (Primary MV disease) OR Functional/Acquired Mitral valve disease (Endocarditits, Chordae Rupture)

8

Myxomatous mitral valve disease causing regurgitation

Primary mitral valve disease….. Leaflets are myxomatous (leafles no longer fibrous & pliable, but floppy & redundant)….. Associated w/CT disease… Hereditary … Results in prolapsed, redundancy, and incompetence of the valve

9

Mitral valve prolapsed – sequlae

Long asymptomatic course ---> Left atrial enlargement (atrial arrhythmias – fibrillation) w/leakiness ---> Left ventricle volume overload (LV dilation/dysfunction) ---> HF symptoms (dyspnea, orthopnea, edema, etc.) & Risk of endocarditis

10

Mitral valve prolapse – characteristics on physical exam

Mild systolic click (when valve opens suddenly)….. Late diastolic or holosystolic murmur (classically at apex)….. Maneuveurs that decrease LV size --->intensify/prolong murmur (valsalva, dehydration)….. Maneuveurs that increase LV size ---> decrease murmur (squatting, hydration)

11

Myxomatous mitral valve – treatment

No great medial treatment (Afterload reduction by reducing systemic BP, HF symptoms treatment via diuretics) …. Surgical treatment is usually the best option (repair/replace)

12

Mitral valve regurgitation – Functional Mitral Valve disease

Primarily a LV problem (thus secondarily a valve problem) – dilating LV dilates the mitral valve w/it and pulls the chordae/papillary muscles down, which restricts the valve from closing… restriction of leaflets, tethering of chordea, dilatation & flattening of annulus

13

Functional Mitral Valve Regurgitation – characteristics on physical exam

Holosystolic murmur at apex (quiet S1)….. Signs of LV dysfunction (S3, S4… Loud P2, associated w/pulmonary HTN… Lateral displacement of apical impulse… Edema, crackles, JVD (HF)

14

Functional Mitral Valve disease – treatment

Medical treatment is the best option (Since the primary problem is the LV, treat underlying cardiomyopathy) – ACEIs, BBs, Spironolactone, Revascularization, Bi-ventricular pacing, Transplant….. Primary mitral valve surgery (controversial b/c valve isn’t the 1st problem & has mixed results)

15

Mitral stenosis – defn

Restricted opening of the mitral valve from a chronically thickened valve

16

Mitral stenosis –causes

Rheumatic heart disease (Abs produced during rheumatic fever attack the valve many years later)….. Rarely, senile calcification (age, renal disease)

17

Rheumatic fever & Mitral stenosis

Childhood illness….. Immune response to strep throat…. Acute disease: chorea (jerky movements of limbs, trunk, facial muscles), rash, fever, arthritis for 2-4 weeks after strep infection….. Valvulopathy can happen years later ….. Prophylactic treatment w/Penicillin until 18-21 yo or risk of strep throat low (longer for those w/valvulopathy or with increased exposure to strep – at least age 40) – once you have demonstrated that you produce antibodies, each time you get strep you’ll produce more, so this is prevented prophylactically

18

Mitral stenosis – sequlea

Long asymptomatic period ---> Left atrial enlargement (can be massive; atrial arrhythmias, clots, strokes)---> HF symptoms (dyspnea, edema, orthopnea…)---> Pulmonary HTN (RV dysfunction, tricuspid regurgitation)

19

Mitral stenosis – characteristics on physical exam

Louds S2….. Opening snap (S2-OS time shorter w/more severe stenosis)….. Diastolic rumble at apex w/pt lying on left size….. Signs of pulmonary HTN (loud P2, RV thrill/lilt, JVD, Tricuspid regurgitation murmur)

20

Measuring stenosis

Measure velocity of blood through the valve… stenosis = “thumb over the hose” = blood comes out faster the more restrictive/stenotic the valve is

21

Mitral stenosis – treatment

Valvuloplasty (balloon to crack open; can’t use if there is regurgitation or if too calcified that they crack like an egg)….. Surgical replacement….. Medical (not curative): BBs (more time for blood to flow during diastole), Diuretics (for HF), Anticoagulation, Antibiotics (prophylactic)

22

Tricuspid valve anatomy

Little sister of the mitral valve; 3 leaflets + 3 papillary muscles

23

Tricuspid valve disease

Almost always a secondary functional valvular disease due to right HF or pulmonary HTN….. Primary Tricuspid Valve disease is rare, and occurs in the setting of (1) Congenital Heart Disease - Epstein’s Abnormality where posterior leaflet grows down instead of across; (2) Endocarditis - esp. in IV drug users; (3) Carcinoid (serotonin produced w/carcinoid tumor in liver ---> goes to right heart & attack tricuspid/pulmonic valves ---> lungs metabolize, spare left valves; OR (4) Rheumatic - caused much less often than mitral valve disease

24

Tricuspid Regurgitation - Sequlae

Associated w/underlying RV disease & Pulmonary HTN – Edema, JVD, Hepatic congestion

25

Tricuspid regurgitation – characteristics on physical exam

Holosystolic murmur – left lower sterna border, increases w/inspiration, loud P2 (w/pulmonary HTN)

26

Tricuspid stenosis – cause

Rare – Carcinoid syndrome (via tumor-produced serotonin; stuck open = stenosis & regurgitation)

27

Tricuspid stenosis – sequlea

Right heart symptoms – JVD, edema, hepatic congestion

28

Tricuspid stenosis – characteristics on physical exam

Diastolic murmur at left lower sterna border, increasing w/inspiration (hard to hear)

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