Mitral Valve Disease

Question 1

What is the most common cause of mitral stenosis?

Answer 1

rheumatic heart disease

Question 2

What is mitral stenosis?

Answer 2

Mitral stenosis (MS) involves narrowing of the mitral valve, which results in decreased filling of the left ventricle during systole and increased left atrial pressure (due to incomplete left atrial emptying).

Question 3

What murmur is mitral stenosis associated with?

Answer 3

Mitral stenosis is associated with a low-pitched, rumbling, mid-diastolic murmur heard loudest over the apex.

Question 4

What group of bacteria causes rheumatic fever?

Answer 4

group A beta-haemolytic streptococcus

Question 5

Is mitral stenosis more common in men or women?

Answer 5

Women

Question 6

What are 4 other rarer causes of mitral stenosis?

Answer 6

1. Congenital
2. Left atrial myxoma
3. Connective tissue disorders
4. Mucopolysaccharidosis

Question 7

Where is the mitral stenosis murmur loudest on expiration?

Answer 7

Left lateral decubitus position

Question 8

Give 6 presenting features of mitral stenosis:

Answer 8

1) dyspnoea
2) fatigue
3) palpitations
4) chest pain
5) haemoptysis
6) atrial fibrillation

Question 9

Describe the pathophysiology of mitral valve stenosis: (2)

Answer 9

1) increased atrial pressure is required to pass blood through the stenosed mitral valve, causing LA hypertrophy and dilation
2) increased atrial pressure creates backlog, increasing pulmonary and right heart pressure, leading to pulmonary oedema and RV hypertrophy, dilation and failure

Question 10

Give 4 clinical signs of mitral stenosis:

Answer 10

1) malar flush
2) small-volume pulse
3) raised JVP
4) opening snap sound of valves suddenly followed by low-pitched rumbling mid diastolic murmur

Question 11

Describe the appearance of malar flush:

Answer 11

bilateral, cyanotic or dusky pink discolouration of upper cheeks

Question 12

What does a raised JVP indicate?

Answer 12

right sided heart failure

Question 13

Describe the technique used to auscultate the mitral valve:

Answer 13

use the BELL of the stethoscope at the apex of the heart with the patient lying on their left side in expiration

Question 14

Describe the appearance of a CXR for mitral valve stenosis:

Answer 14

LA enlargement

Question 15

Name 3 key investigations of valvular heart disease:

Answer 15

1) chest x-ray
2) echocardiogram
3) ECG

Question 16

Describe how an ECG for a patient with mitral valve stenosis may present: (2)

Answer 16

1) bifid p wave (due to delayed left atrial activation)
2) may show signs of atrial fibrillation

Question 17

Give 3 treatments for mitral valve stenosis:

Answer 17

1) diuretics for pulmonary oedema
2) mitral valve replacement
3) valvulotomy

Question 18

What is mitral reguritation?

Answer 18

Mitral regurgitation (MR) occurs when there is backflow (regurgitation) of blood from the left ventricle into the left atria (through the mitral valve) during ventricular systole.

Question 19

What murmur is mitral regurgitation associated with?

Answer 19

Mitral regurgitation is associated with a pansystolic murmur heard loudest over the mitral area and radiating to the axilla.

Question 20

Abnormalities of which 4 cardiac structures can cause mitral regurgitation:

Answer 20

1) valve leaflets
2) annulus
3) chordae tendineae
4) papillary muscles

Question 21

Give the 7 most frequent causes of mitral regurgitation:

Answer 21

1) ischaemic heart disease
2) calcification in old age
3) infectious endocarditis
4) rheumatic heart disease
5) cardiomyopathy
6) Marfan’s and Ehlers-Danlos syndrome
7) SLE

Question 22

Describe the pathophysiology of acute mitral regurgitation: (2)

Answer 22

1) regurgitation into the left atrium produces left atrial dilation
2) in acute cases, the LA does not have time to dilate and compensate, leading to increased LA pressure and thus increased pulmonary pressure -> pulmonary oedema

Question 23

Give 4 presenting symptoms of mitral regurgitation:

Answer 23

1) dyspnoea
2) orthopnoea
3) fatigue
4) lethargy

Question 24

Give 6 signs of mitral regurgitation:

Answer 24

1. Pan systolic murmur (due to regurgitation in systole)
2. Soft first heart sound (incomplete closing of the mitral valve)
3. prominent third heart sound (due to sudden rush of blood back in LA)
4. Mid systolic click (floppy mitral valves may suddenly prolapse)
5. laterally displaced forceful diffuse apex beat and systolic thrill in severe cases
6. signs of AF, pulmonary hypertension and left and right heart failure develop later in disease

Question 25

Give 3 methods of investigations and their positive findings for mitral regurgitation:

Answer 25

1) chest x-ray -> LA and LV enlargement
2) echocardiogram -> dilated LA and LV
3) ECG -> bifid p waves (LA delay) and LV hypertrophy signs

Question 26

Give 3 ECG signs of LV hypertrophy:

Answer 26

1) tall R wave
2) deeply inverted T wave on left chest leads
3) deep S waves on right sided chest leads

Question 27

What is the main treatment method for mitral regurgitation?

Answer 27

valve repair/replacement

Question 28

What is a mitral valve prolapse?

Answer 28

A mitral valve prolapse occurs when the mitral valve leaflets prolapse into the left atrium during systole.

Mitral valve prolapse is associated with a combination of a mid-systolic click and mid to late-systolic murmur.