Mitral & Tricuspid valve disease Flashcards Preview

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Flashcards in Mitral & Tricuspid valve disease Deck (55)
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1

Mitral valve anatomy

1) annulus

2) leaflets

3) chordae- attach tips of leaflets to papillary muscle

4) papillary muscles- anchor leaflets to myocardium

2

what does mitral valve separate?

LA and LV

3

when does mitral valve open and when does it close

open in diastole

close in systole (prevent backflow)

4

what happen in mitral stenosis

decr mitral valve open

obstruct flow from LA to LV

incr Pressure in LA, pulm vasculature, right heart

5

most common etiology of mitral stenosis

rheumatic MS

calcific MS (old age and renal disease)

6

causes of rheumatic stenosis

acute rheumatic fever (only 50%)

7

what is acute rheum fever

inflammation of heart, skin, CT
by URI (group A strep)

2-3 wk after strep throat

8

effect of acute rheum fever in heaeart

inflammation of valvular endocardium --> chronic rheum heart disease

9

clinical effect of mitral stenosis

1) dyspnea

2) hemoptysis

3) pulm HTN

4) R sided heart failure (edema,ascites)

5) afib

6) embolic stroke

10

what causes dyspnea in mitral stenosis

(incr LA pressure, incr pulm venous + capillary P --> pulm edema (fluid in pulm interstitium)

11

what causes hemoptysis in mitral stenosis

incr pulm vascular pressure, rupture of bronchial vein into lung parenchyma

12

what causes right sided heart failure in mitral stenosis

RV pump against high resistance from pulm HTN

13

what causes afib in mitral stenosis

chronically high LA pressure --> LA dilation

14

what causes emb stroke in mitral stenosis

stagnant blood flow in LA --> blood clot

15

what heart sound with mitral stenosis

Listen over apex
1) loud S1 (high AV pressure gradient keeps MV open until last sec when systole closes valve)

2) opening snap after S2

3) diastolic rumble (low freq descrendo due to turbulence across stenotic valve)

16

severity of MS inversely proportional to ____

interval between S2 and opening snap

high LA pressure opens valve earlier

17

Mitral stenosis on ekg?

1) left atrial enlargement

2) RVH if pulm HTN present

3) afib

18

Mitral stenosis on echo?

1) left atrial enlarge

2) poor open of valve during diastole

3) thick leaflet, fusion of commissure

19

mitral stenosis treatment

1) beta blocker to slow HR so more time for blood to cross valve

2) diuretic to treat CHF sx

3) anticoag if afib = warfarin

4) mitral valve replacement

20

types of mitral valve stenosis interventions

percutaneous balloon mitral valvuloplasty vs. valve replacement

21

define percutaneous balloon mitral valvuloplasty

1) catheter into LV

2) pull balloon until against mitral valve, then expand the balloon

3) open mitral valve and relieve stenosis

22

indications for intervention with mitral stenosis

1) sx
2) afib
3) pulm HTN

23

mitral regurg define

inadeq mitral valve closure so blood flow back into LA during systole

24

causes of mitral regurg?

1) myxomatous degeneration (mitral valve prolapse)- MAIN

2) chordal rupture and LV dysfxn)

3) endocarditis (valve deform/perf)

4) rheum valve disease

5) LV enlargement (stretch mitral annulus/papillary)

25

mitral regurg physical exam

holocystolic murmur heard at apex and radiate to axilla

26

mitral valve prolapse

asymptomatic and benign

concern for mitral regurg

27

hemodynamics of mitral regurg

1) part of LV stroke volume eject backwards

2) incr LA volume/pressure --> pulm HTN + edema

3) decr fwd CO

4) stress on LV

28

clinical effect of mitral regurg

CHF

1) dyspnea on exertion

2) orthopnea

3) parox nocturnal dyspnea

4) edema

LA Dilation
1) afib

29

treatment of mitral regurg- meds

diuretics for CHF

decr afterload (ACE inhib, ARB)

30

treatment of mitral regurg- surgery

mitral valve repair (preferred) or replacement