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Flashcards in L32 Deck (28):
1

Cause of mitral stenosis

Rheumatic heart disease

2

Pathophys and symptoms of mitral stenosis

Stiff valve - less blood into LV
More pressure in the LA --> higher pulm pressures
Symptoms = CHF
- DOE
- Fatigue
- SOB
- Orthopnea/PND

3

So what kind of HF does mitral stenosis cause?

HF w/ normal LV filling pressure
The exception to the rule since all other HFs have this

4

Does the LA change size due to mitral stenosis? What do said changes increase the risk of?

Dilation b/c high P
Higher risk AFib

5

Which ventricle is more likely to fail with mitral stenosis

RV

6

How do these factors change throughout mitral stenosis
1. Arterial pulse
2. Apical impulse
3. JVP

All normal!
Until... develop pulm HTN
1. Loud P2 arterial pulse
2. RV heave
3. Large "a" wave in JV pattern

7

Mitral stenosis auscultation - 3 pts

1. Opening snap = stiff valve opens, after S2
2. Diastolic (after S2) low pitched murmur
3. Loud S1
"Lubb dup dup purr"

8

What might be included in the diastolic mitral stenosis murmur?

Pre-systolic accentuation - gets louder closer to systole

9

Best place to hear MS

L lateral decubitus

10

Scan images for MS

LA dilated/enlarged
RV hypertrophy
**STRAIGHT heart border +/- elevated L bronchi +/- esophagus out of the way

11

3 pts of mitral valve stenosis treatment

1. Decrease LA pressure - diuresis
2. Manage AFib
3. Meds to prevent clots

12

2 surg options for MS

Commissurotomy
Replacement

13

Primary mitral regurg

Pathology of valve componenets

14

Secondary mitral regurg

1ary problem = dilated LV
2ary problem is dilation means valve won't close correctly

15

Pathophys mitral regurg

LV blood --> LA b/c lower P here
LV sees larger vol load b/c = diastolic filling + reflux blood from LA
Increase LV stroke volume to get the normal amt of blood into aorta while losing some to LA = DILATION

16

What is EF good or bad for dilated heart under volume overload?

Good = high EF

17

Is EF good or back for pumping if b/c of cardiomyopathy or ESRD

Bad pump = low EF

18

LA and LV size and pressures in acute MR

Normal LV and LA size
High pressure in LA due to higher volume in same sized atria - P reflected in lungs

19

LA and LV size and pressures for chronic MR

LA & LV dilated
Pressures are normal due to dilation over time to accommodate sustained pressures due high volume

20

Presentation MR

CHF

21

3 findings of MR auscultation

1. Holosystolic murmur = bet S2-3
2. S3
3. Palpable hyperdynamic apex

22

What shows in cath lab for MR

V wave in cap wedge position

23

Treat acute vs chronic MR

Acute - IV nitroprusside + intra-aortic balloon
Chronic - vasodilate PO

24

2 surg options for MR

Repair
Replace

25

Mitral prolapse pathphys

Less collagen/elastin
More myxomatous - looser tissue in valve
- Inherited degenertation

26

What dictates the symptoms of mitral prolapse

Degree of associated MR
Aka common for regurg to develop 2ary

27

Auscultation for mitral prolapse

Mid-late systolic click
Late systolic murmur
CHANGES w/ MANEUVERS

28

What type of mitral prolapse do you treat?

Ruptured chordae -> flailing leaflet
Acute, severe