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

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

Mitral & tricuspid valve – timing of opening

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


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


Mitral valve anatomy - parts

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


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)


Mitral valve leaflest

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


Mitral valve pathology

Regurgitation/insufficiency OR Stenosis


Primary mitral valve disease (regurgitation) – causes

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


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


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


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)


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)


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


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)


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)


Mitral stenosis – defn

Restricted opening of the mitral valve from a chronically thickened valve


Mitral stenosis –causes

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


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


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)


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)


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


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)


Tricuspid valve anatomy

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


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


Tricuspid Regurgitation - Sequlae

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


Tricuspid regurgitation – characteristics on physical exam

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


Tricuspid stenosis – cause

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


Tricuspid stenosis – sequlea

Right heart symptoms – JVD, edema, hepatic congestion


Tricuspid stenosis – characteristics on physical exam

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

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