Mitral valve disease Flashcards Preview

Year 2 Cardiovascular > Mitral valve disease > Flashcards

Flashcards in Mitral valve disease Deck (25):
1

what are the etiologies of mitral regurg?

rheumatic disease
infective endocarditis
collagen vascular disease
cardiomyopathy
ischemic heart disease
mitral valve prolapse

2

which conditions affect the mitral valve leaflets in MR?

chronic rheumatic heart disease
infective endocarditis

3

which conditions affect the mitral annulus in MR?

dilation
calcification

4

what is the pathophysiology of MR?

1. impedance to LV ejection (afterload) is LOWERED
2. eventual LV decompensation and failure occur

5

in early MR is the ejection fraction high or low?

high

6

what are the hemodynamics of severe, symptomatic MR?

1. ejection fraction normal to low
2. excess volume maintained in LA and pulmonary circulation
3. LV goes into diastolic overload and fails

7

how does regurgitation of blood into LA relate to LA end systolic pressure and volume in MR?

higher LA end systolic pressure and volume

8

what is the principal symptom of MR?

dyspnea

9

what do the carotid artery pulses feel like in MR? why?

sharp in severe MR

higher SVs

10

what is heard upon auscultation in MR?

S1 - commonly soft if MV leaflets still flexible
S2 - widely split (earlier A2)
A2 commonly softer than P2 if pulmonary HTN
S3 is common in LV
tricuspid murmur
S4 in RV (pumonary HTN)

11

what are the features of the murmur heard in MR?

holosystolic
blowing, loudest at apex
radiates to axilla
commences with S1
occasionally lasts through S2
constant loudness

occasionally, patients with MR will have a diastolic murmur commencing with S3

12

which is more important for a murmur - intensity or duration?

duration

13

what are the CXR features of MR?

enlarged LA
possibly mitral annulus calcification

14

what is the best test for MR?

echo

15

what is the general treatment for MR?

afterload reduction - ACE inhibitors

nitroprusside if acute
dobutamine if hypotensive

16

what is the main cause of mitral stenosis?

rheumatic fever

17

what is the pathophysiology of mitral stenosis?

obstruction to LV inflow leading to pressure gradient across the valve

18

what is the surface area of the MV orifice in mild mitral stenosis? critical?

mild - 2 cm squared

critical - 1 cm squared or less

19

what may be the first symptom of mitral stenosis?

embolization

20

systemic embolization in the context of mitral stenosis is related to what factors?

1. size of LA appendage
2. level of cardiac output
3. presence of atrial fibrillation

21

what are the physical exam findings in mitral stenosis?

mitral facies
arterial pulses normal to reduced
apical impulse is onconspicuous to absent

22

what is pathognomonic for mitral stenosis?

loud S1
opening snap at apex after P2 but before S3
S4 in RV (pulmonary HTN)

23

where / how is the murmur for mitral stenosis heard?

low pitched, rumblinb, mid-diastolic heard with bell at LV apex in LLD

24

what is a graham-steell murmur a sign of?

severe pulmonary HTN

25

what test is the cornerstone of mitral stenosis diagnosis?

echo