Mitral Regurgitation Flashcards

1
Q

what are the problems of leaflets causing mitral regurgitation ?4

A
  • prolapse
  • rheumatic
  • myxomatous
  • endocarditis - relatively common
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2
Q

what is prolapse normally due to

A

usually due to chordal rupture. You can get congenital rupture

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3
Q

what causes a floppy (myxomatous) valve?

A

probably degenerative. You get a thickened, billowing mitral valve - barlow’s valve

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4
Q

what are the other causes of MR?

A

chordae rupture

  • papillary muscle rupture
  • annular dilatation
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5
Q

what can cause papillary muscle rupture?

A

ischaemia

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6
Q

papillary muscle rupture can cause ________

A

severe pulmonary oedema

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7
Q

most patients with heart failure have some form of ______

A

annular dilatation

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8
Q

Regurgitation into the left atrium produces ___ _______.

A

Regurgitation into the left atrium produces LA dilatation.

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9
Q

with acute mitral regurgitation the normal compliance of the left atrium does not allow much _______ and the left atrial pressure ____

A

with acute mitral regurgitation the normal compliance of the left atrium does not allow much dilatation and the left atrial pressure rises

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10
Q

Pulmonary venous pressure can rise and produce _____ ______

A

Pulmonary venous pressure can rise and produce pulmonary oedema

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11
Q

what are the symptoms?

A
  • breathlessness
  • peripheral oedema
  • fatigue
  • CCF
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12
Q

why breathlessness?

A

pulmonary venous hypertension

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13
Q

why peripheral oedema?

A

patients can develop RHF due to back pressure effects

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14
Q

why fatigue?

A

due to reduced CO

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15
Q

what happens to the apex beat?

A

displaced diffuse - get cardiomegaly

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16
Q

what can be felt on examination if MR is severe?

A

systolic thrill

17
Q

what is the first heart sound like?

A

soft

18
Q

what kind of murmur may be heard?

A

pansystolic murmur

19
Q

where does the murmur radiate to ?

A

the axilla

20
Q

what is the other sound heard?

A

prominent 3rd heart sound

21
Q

why is there a prominent 3rd heart sound

A

owing to the sudden rush of blood back to the dilated left ventricle in early-mid diastole

22
Q

what is the most common cause of MR?

A

functional with HF

23
Q

what is the treatment for MR in HF?

A

treat the HF aggressively

24
Q

what medication may be given?

A

diuretics and ACEi (HF)

25
Q

what surgical treatment options are there?

A

repair

replacement

26
Q

when is repair done?

A

if there is not much calcification

27
Q

which group do not get surgery ?

A

people with heart failure

28
Q

what can be done percutaneously ?

A

clips in infancy

29
Q

what is a prolapsing mitral valve called?

A

barlow’s syndrome or floppy mitral valve

30
Q

why is the valve floppy ?

A
  • excessively large mitral valve leaflets,
  • an enlarged mitral annulus,
  • abnormally long chordae or
  • disordered papillary muscle contraction.
31
Q

what are the causes of barlow’s ?

A
  • marfans,
  • thyrotoxicosis,
  • rheumatic or
  • ischaemic heart disease
  • also occurs with ASD and as part of HCm
32
Q

what are the symptoms of barlow’s ?

A
  • atypical chest pain - sub mammar. Sometimes it is substantial, aching and severe
  • palpitations - may occur
33
Q

what are the signs of barlow’s ?

A

mid-systolic click

34
Q

why is there a mid systolic click in barlow’s

A

produced by the sudden prolapse of the valve and the tensing of the chordae tendinae that occurs during systole

35
Q

what is the treatment for barlow’s

A

beta -blockade is effective for the chest pain and palpitations