Flashcards in Mitral valve disease Deck (25)
what are the etiologies of mitral regurg?
collagen vascular disease
ischemic heart disease
mitral valve prolapse
which conditions affect the mitral valve leaflets in MR?
chronic rheumatic heart disease
which conditions affect the mitral annulus in MR?
what is the pathophysiology of MR?
1. impedance to LV ejection (afterload) is LOWERED
2. eventual LV decompensation and failure occur
in early MR is the ejection fraction high or low?
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
how does regurgitation of blood into LA relate to LA end systolic pressure and volume in MR?
higher LA end systolic pressure and volume
what is the principal symptom of MR?
what do the carotid artery pulses feel like in MR? why?
sharp in severe MR
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
S4 in RV (pumonary HTN)
what are the features of the murmur heard in MR?
blowing, loudest at apex
radiates to axilla
commences with S1
occasionally lasts through S2
occasionally, patients with MR will have a diastolic murmur commencing with S3
which is more important for a murmur - intensity or duration?
what are the CXR features of MR?
possibly mitral annulus calcification
what is the best test for MR?
what is the general treatment for MR?
afterload reduction - ACE inhibitors
nitroprusside if acute
dobutamine if hypotensive
what is the main cause of mitral stenosis?
what is the pathophysiology of mitral stenosis?
obstruction to LV inflow leading to pressure gradient across the valve
what is the surface area of the MV orifice in mild mitral stenosis? critical?
mild - 2 cm squared
critical - 1 cm squared or less
what may be the first symptom of mitral stenosis?
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
what are the physical exam findings in mitral stenosis?
arterial pulses normal to reduced
apical impulse is onconspicuous to absent
what is pathognomonic for mitral stenosis?
opening snap at apex after P2 but before S3
S4 in RV (pulmonary HTN)
where / how is the murmur for mitral stenosis heard?
low pitched, rumblinb, mid-diastolic heard with bell at LV apex in LLD
what is a graham-steell murmur a sign of?
severe pulmonary HTN