Mitral Stenosis

Question 1

What is the Mitral Valve Annulus?

Answer 1

Anatomic junction between LA and LV

LA: Left Atrium, LV: Left Ventricle

Question 2

Describe the basic shape of the Mitral Valve Annulus.

Answer 2

Basically D-shaped, with a straight section representing the aortomitral curtain

Question 3

What type of continuity exists between the aortic valve annulus and the anterior MV leaflet?

Answer 3

Fibrous continuity

Question 4

How does the three-dimensional shape of the Mitral Valve Annulus appear?

Answer 4

More complex and appears more like a ‘saddle’

Question 5

What passes through the medial trigone?

Answer 5

AV conduction system

Question 6

What is the most common cause of inflammatory etiology in valvular heart disease?

Answer 6

Rheumatic fever

Rheumatic fever is a significant cause of heart valve issues, particularly in younger populations.

Question 7

What are the degenerative causes of valvular heart disease?

Answer 7

Calcification (elderly)

Calcification of heart valves is often seen in older adults, leading to stenosis or regurgitation.

Question 8

Name a structural cause of valvular heart disease associated with carcinoid.

Answer 8

Thickened/restricted leaflets

Carcinoid syndrome can lead to fibrous and thickened heart valves, particularly affecting the right side of the heart.

Question 9

What type of tumor can cause left atrial obstruction in valvular heart disease?

Answer 9

Myxoma

A myxoma is a benign tumor that can obstruct blood flow and mimic mitral stenosis.

Question 10

What is a genetic condition associated with structural heart defects leading to valvular issues?

Answer 10

Congenital Heart Disease (CHD)

Conditions like parachute mitral valve or double orifice mitral valve are examples of congenital heart defects.

Question 11

Fill in the blank: _______ is a rare congenital heart disease characterized by supravalvular membrane.

Answer 11

Shone’s syndrome

Shone’s syndrome involves multiple left heart obstructive lesions, including a supravalvular membrane.

Question 12

What is the term for a mitral valve with all chordae attached to one papillary muscle?

Answer 12

Parachute mitral valve

This anomaly can lead to significant mitral regurgitation due to abnormal leaflet motion.

Question 13

What is the principal symptom associated with high LAP/PCWP/PHTN?

Answer 13

Dyspnea at rest or on exertion (DOE)

Dyspnea is a common symptom in various cardiac conditions, indicating difficulty in breathing.

Question 14

What is hemoptysis?

Answer 14

Bloody sputum due to high pressure in lung

Hemoptysis is often a sign of underlying pulmonary or cardiac issues.

Question 15

What causes fatigue in patients with high LAP/PCWP/PHTN?

Answer 15

Low cardiac output (CO)

Fatigue can indicate inadequate perfusion of tissues due to reduced heart efficiency.

Question 16

What symptom is associated with arrhythmia due to LAE/high pressure?

Answer 16

Palpitations

Palpitations may occur when the heart experiences irregular rhythms, often due to structural changes.

Question 17

What is syncope and how is it related to cardiac conditions?

Answer 17

Loss of consciousness due to low cardiac output

Syncope can result from inadequate blood flow to the brain, often linked to heart dysfunction.

Question 18

What is a late finding in high LAP/PCWP/PHTN that indicates right heart failure?

Answer 18

Right heart failure

Right heart failure can occur as a result of prolonged pressure overload in the pulmonary circulation.

Question 19

What arrhythmia may present due to a big left atrium and high pressure?

Answer 19

Atrial fibrillation (AFib)

Atrial fibrillation can occur due to structural changes in the heart, particularly in the atria.

Question 20

What is a murmur in cardiac auscultation?

Answer 20

Low-pitched diastolic ‘rumble’ at the apex

Murmurs can indicate various cardiac conditions and are assessed for timing, pitch, and quality.

Question 21

What is the significance of the opening ‘snap’ sound in cardiac auscultation?

Answer 21

Correlates with the forceful opening of the mitral valve (MV)

The opening snap is an important physical sign in diagnosing mitral stenosis.

Question 22

What does a loud S1 indicate in cardiac auscultation?

Answer 22

Increased force to close the valve

A loud S1 may suggest conditions such as hyperdynamic circulation or mitral valve closure abnormalities.

Question 23

What is the purpose of prophylactic antibiotics in medical treatment?

Answer 23

To avoid recurrence of RF

RF refers to rheumatic fever.

Question 24

Name two antiarrhythmic medications used in medical treatment.

Answer 24

• Digitalis
• Amiodarone

Question 25

What is the role of beta blockers in medical treatment?

Answer 25

Slows HR, improves filling

Question 26

What do diuretics do in medical treatment?

Answer 26

Rids the body of excess fluid

Question 27

Why is activity restriction recommended in medical treatment?

Answer 27

To avoid DOE and acute CHF

Question 28

What is cardioversion used for?

Answer 28

For AFib only

Question 29

What is the purpose of the Maze procedure?

Answer 29

For AFib-atrial remapping only

Question 30

What is balloon valvuloplasty?

Answer 30

Cracking the valve open

Question 31

What is commissurotomy?

Answer 31

Cracking the valve open

Question 32

What are the options for mitral valve replacement?

Answer 32

* Mechanical * Bio

Question 33

What is Rheumatic Valve Disease?

Answer 33

Occurs secondary to episode(s) of acute rheumatic fever (ARF) ## Footnote Rheumatic Valve Disease is a condition that develops as a complication of ARF.

Question 34

What type of response causes damage to the mitral valve apparatus in Rheumatic Valve Disease?

Answer 34

Autoimmune response several years after ARF ## Footnote This autoimmune response leads to chronic damage to the heart valves.

Question 35

What does MS stand for in the context of Rheumatic Valve Disease?

Answer 35

Mitral Stenosis ## Footnote MS refers to the narrowing of the mitral valve opening.

Question 36

What are the key structural changes that occur in the mitral valve due to MS?

Answer 36

Thickening/fibrosis of MVLs, commissural fusion & shortening/matting of tendinous cords ## Footnote MVLs stands for mitral valve leaflets.

Question 37

What is the characteristic shape of the mitral valve orifice in MS?

Answer 37

"fish mouth" MV orifice ## Footnote This term describes the appearance of the narrowed valve opening.

Question 38

What is a common complication associated with the leaflets and cords in Rheumatic Valve Disease?

Answer 38

Calcification of commissures, leaflets and cords ## Footnote Calcification contributes to the stiffness and dysfunction of the valve.

Question 39

What is the appearance of the anterior mitral valve (MV) leaflet in rheumatic mitral stenosis?

Answer 39

Doming 'Hockey Stick' Appearance ## Footnote This appearance is characterized by a distinct shape resembling a hockey stick due to the leaflet's deformation.

Question 40

What are the characteristics of the leaflets in rheumatic mitral stenosis?

Answer 40

Thickened leaflets, especially at the tips ## Footnote This thickening contributes to the obstruction of blood flow through the mitral valve.

Question 41

True or False: In rheumatic mitral stenosis, the anterior mitral valve leaflet typically appears thin and flexible.

Answer 41

False ## Footnote The anterior mitral valve leaflet is thickened in rheumatic mitral stenosis.

Question 42

Fill in the blank: The anterior mitral valve leaflet in rheumatic mitral stenosis has a _______ appearance.

Answer 42

Doming 'Hockey Stick' ## Footnote This specific appearance is a key diagnostic feature in imaging studies.

Question 43

What are the M-Mode findings in MS?

Answer 43

Thickened, restricted leaflets ## Footnote Refers to the abnormal appearance of the mitral valve leaflets in mitral stenosis.

Question 44

What is the significance of the decreased 'E-F' slope in M-Mode findings?

Answer 44

Indicates doming of the anterior mitral valve leaflet ## Footnote The 'E-F' slope is a measurement related to diastolic function and can indicate mitral valve abnormalities.

Question 45

Fill in the blank: The M-Mode finding of thickened, restricted leaflets is associated with _______.

Answer 45

[mitral stenosis]

Question 46

True or False: Decreased 'E-F' slope is a sign of improved diastolic function.

Answer 46

False ## Footnote A decreased 'E-F' slope suggests impaired diastolic function due to mitral valve abnormalities.

Question 47

What is the primary degenerative process in Extensive MAC?

Answer 47

Usually affecting posterior annulus > anterior

Question 48

Which conditions are frequently associated with Extensive MAC?

Answer 48

* FED * Barlow's * Marfan's * Diabetes * Renal dialysis patients

Question 49

What does MS result from in the context of Extensive MAC?

Answer 49

Extension of MAC onto leaflets, reducing mobility

Question 50

Are leaflet tips affected by calcium deposits in Extensive MAC?

Answer 50

Leaflet tips are usually spared from calcium deposits

Question 51

Is there commissural fusion in Extensive MAC?

Answer 51

NO commissural fusion, as with rheumatic disease

Question 52

What is MAC

Answer 52

Mitral Annulus Calcification

Question 54

What is Cor Triatriatum?

Answer 54

A rare congenital heart defect characterized by a membrane across the left atrium

Question 55

What does Cor Triatriatum mimic?

Answer 55

It mimics mitral stenosis (MS)

Question 56

True or False: Cor Triatriatum is a common congenital heart defect.

Answer 56

False

Question 57

Cor Triatriatum creates obstruction in which part of the heart?

Answer 57

Left atrium

Question 58

Fill in the blank: Cor Triatriatum is a rare condition that involves a membrane across the _______.

Answer 58

left atrium

Question 59

2D planimetry values for mitral stenosis

Answer 59

• Normal > 4 cm2 • Mild MS > 1.5 cm2 • Moderate 1-1.5 cm2 • Severe < 1 cm2

Question 60

MVA equation

Answer 60

MVA = 220/p1/2t