FN: Mitral Regurgitation Flashcards Preview

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Flashcards in FN: Mitral Regurgitation Deck (16):
1

Causes

1. Mitral valve prolapse
2. LV dilatation: AR, AS, HTN
3. Annular calcification - contraction (elderly)
4. Post-MI: papillary muscle dysfunction/rupture
5. Rheumatic fever
6. Connective tissue: Marfans, ehlers-danlos

2

Symptoms

Dyspnoea, faitgue
AF - palpitations + emboli
Pulmonary congestion - HTN + oedema

3

Signs

AF
Left parasternal heave (RVH)
Apex: displaced
Heart sounds
Murmur

4

Apex

Displaced
Volume overload as ventricle has to pump forward SV and regurgitant volume - eccentric hypertrophy

5

Heart sounds

Soft S1
S2 not heard separately from murmur
Loud P2 (if PTH)

6

Murmur

blowing PSM
Apex
Left lateral position in end expiration
Radiates to the axilla

7

Clinical indication of Severe MR

Larger LV
Decompensation: LVF
AF

8

Differential

AS
TR
VSD

9

Investigations

bloods
ECG
CXR
Echo
Cardiac catheterisation

10

Bloods

FBC
U+E
Glucose
Lipids

11

ECG

AF
P mitrale (unless in AF)
LVH

12

CXR

LA and LV hypertrophy
Mitral valve calcification
Pulmonary oedema

13

Echo

Doppler echo to assess MR severity: multiple ccriteria
1. Jet width (vena contracts) >0.6cm
2. Systolic pulmonary flow reversal
3. Regurgitant volume >60ml

TOE to assess severity and suitability of repair cf. replacement

14

Cardiac catherisation

Confirm Dx
Assess CAD

15

Management medical

Optimise RFs: statins, anti-hypertensives, DM
Monitor: regular f/up with echo
AF: rate control and anticoagulate - also anticoagulate if hx of embolism, prosthetic valve, additional MS

Drugs to reduced afterload can help reduce symptoms
1. ACEi or beta-blockers (esp. carvediol)
Diuretics

16

Surgical management

Valve replacement or repair
Indications:
1. Severe symptomatic MR
Severe asympto MR with diastolic dysfunction: reduced EF

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