Mitral Valve Disease

Question 1

What are two types of mitral valve disease?

Answer 1

Mitral regurgitation and Mitral stenosis

Question 2

What happens in mitral regurgitation (MR)?

Answer 2

backflow through mitral valve during systole

Question 3

What are the causes of mitral regurgitation?

Answer 3

1. Functional (LV dilation)
2. Annular calcification (elderly)
3. Rheumatic fever
4. Infective endocarditis
5. Mitral valve prolapse
6. Connective tissue disorders
7. Cardiomyopathy
8. Congenital
9. Appetite suppressants

Question 4

What is mitral valve prolapse?

Answer 4

most common valvular abnormality (5% prevalence)

Question 5

When does mitral valve prolapse occur?

Answer 5

alone or with ASD, patent ductus arteriosis, cardiomyopathy, Turner, Marfarns, etc and mitral annular disjunction (MAD)

Question 6

What are symptoms of mitral valve prolapse?

Answer 6

Usually asymptomatic or chest palpitations and autonomic dysfunction

Question 7

What are the signs for mitral valve prolapse?

Answer 7

mid-systolic click and or a late systolic murmur

Question 8

What are complications of mitral valve prolapse?

Answer 8

1. MR
2. Cerebral emboli
3. arrhythmia
4. sudden death

Question 9

What Ix is diganostic for mitral valve prolapse?

Answer 9

echo

Question 10

What can ECG show for mitral valve prolapse?

Answer 10

t wave inversion or signs of infection

Question 11

What is management for mitral valve prolapse?

Answer 11

1. Beta blocker can help chest pain or palpitation 2. Surgery if severe MR

Question 12

What are causes of mitral stenosis?

Answer 12

1. Rheumatic fever
2. Congenital
3. Prosthetic valve
4. Malignant carcinoid

Question 13

What are RF for mitral stenosis?

Answer 13

1. Strep infection
2. Female sex
3. 40-50

Question 14

What are the symptoms of MR?

Answer 14

1. Dyspnoea
2. Fatigue
3. Palpitations
4. Symptoms of causative factor e.g. fever
5. Lower extremity oedema

Question 15

What are the signs of MR?

Answer 15

1. AF
2. Displaced, hyperdynamic apex
3. Pansystolic murmur at apex radiating to axilla
4. Soft S1
5. Soft S2
   - The more severe the larger the left ventricle

Question 16

When do you get MS symptoms?

Answer 16

begin when orifice >2cm

Question 17

What are symptoms of MS?

Answer 17

Pulmonary hypertension causing

1. Dyspnoea
2. Haemoptysis
3. Chronic bronchitis
4. Hoarseness
5. Dysphagia
6. Fatigue
7. Palpitations
8. Chest pain
9. iE

Question 18

What are the signs in MS?

Answer 18

1. Malar flush (decreased cardiac output)
2. Low volume pulse
3. AF (due to large LA)
4. Tapping non-displaced apex beat
5. RV heave
6. Loud S1
7. Opening snap
8. Rumbling mid-diastolic murmur (heard on expiration with patient on left side)
9. Loud P2
10. Neck vein distention

Question 19

What happens the most severe stenosis in MS?

Answer 19

More severe the stenosis, the longer diastolic murmur and the closer opening snap is to S2

Question 20

What are possible DDx for mitral valve disease?

Answer 20

1. ACS
2. Infective endocarditis
3. Mitral stenosis
4. Aortic stenosis

Question 21

What is diagnostic for both MS and MR?

Answer 21

transthoracic echo

Question 22

What would ECG show on MR?

Answer 22

1. AF
2. P mitrale if in sinus rhythm
3. left ventricular hypertrophy

Question 23

What would ECG show in MS?

Answer 23

1. AF
2. P mitrale
3. RVH

Question 24

What would CXR show in MR?

Answer 24

1. Big LA and LV
2. mitral valve calcification
3. pulmonary oedema

Question 25

What would CXR show in mitral stenosis?

Answer 25

1. LA enlargement 2. pulmonary oedema 3. mitral valve calcification

Question 26

What can cardiac cathertirisation show?

Answer 26

indication are previous valvotomy, signs of other valve disease, angina, severe pulmonary hypertension calcified mitral valve

Question 27

What is the management plan for MR?

Answer 27

1. Control rate if fast AF 2. Anticoagulated if AF, history of embolism, prosthetic valve additional mitral stenosis 3. Diuretics to improve symptoms 4. Surgery for deteriorating symptoms, aim to repair or replace valve before LV irreversibly impaired e.g. annuloplasty

Question 28

What is the management plan for MS?

Answer 28

1. Rate control is crucial 2. Anticoagulants 3. Diuretic to decrease preload and pulmonary venous congestion 4. If these fail to control symptoms can do ballon valvuloplasty, open mitral valvotomy or valve replacement

Question 29

What are complications in MR?

Answer 29

1. AF 2. Pulmonary hypertension 3. Post op stroke 4. LV dysfunction and CHF

Question 30

What are complications in MS?

Answer 30

1. Stroke 2. AF 3. Warfarin induced haemorrhage 4. IE