Mitral Valve Disease Flashcards
(25 cards)
What are causes of Mitral Regurgitation?
Rheumatic Disease Infective Endocarditis Collagen Vascular Disease Cardiomyopathy- Mitral Annulus dilates Ischemic Heart Disease (pappilary muscle dys) Mitral Valve Prolapse
What valve structures are involved in Mitral Regurgitation?
Leaflets -Chronic Rheumatic Heart Disease -Infective Endocarditis Mitral Annulus -Dilation -Calcification Chordae Tendinae -Lengthen and rupture in prolapse -Infective Endocarditis, trauma, rupture of chordae Papillary Muscle -Ischemia -Posterior Papillary Muscle -Rupture from MI is usually fatal (acute pulmonary Edema)
What happens to the Ejection fraction as MR progresses?
Early- Ejection fraction is still high
Severe-EF normal to low
As excess vollume is retained in the LA andpulm circulation LV goes into diastolic overload and fails
What is the pricipal symptoms of Mitral Reguritation?
SOB(Dyspnia)
What are other symptoms of MR?
Palpitations Hemoptysis and systemic emboli Angina Pectoris S and S of RV Failure Hepatic Edema and Ascites
What are physical Exam findings in MR?
Sharp Carotid Artery Pulses
Apical Impulse displaces to the left and down
Left systolic LA thrust palpable at left parasternal area
What is auscultated in mitral Regurg?
S1 Soft S2 widely split A2 softer than P2 S3 commonin LV S4 in RV HOLOSYSTOLIC MURMUR and DIastolic Murmur commencing with S3 DURATION MORE THAN INTENSITY
How is MR imaged?
Electrogardiography
Vegitations and valves can be seen flapping around
What is seen on ECG in Mitral Regurgitation?
Negative terminal movement on P wave and atrial abnormalities
What are medical treatments for MR?
Decrease afterload (ACE-I)
Acute MR - Nitroprusside IV
If in A-Fib, Anticoagulate
Digitalis Glycosides may improve intropism and Slow A-fib
Waht is surgical Treatment for MR?
Mitral Valve Repair
Don’t replace valve as often anymore
Need to be aware of the Coronary vessels BEFORE you start surgery
Can do an annuloplasty and/or reconstruction of cusps
Prolapsing or redundant valve cusps resected.
What are complications of Valve replacement?
Calcification
LV function deterioration from loss of integrity of annulus-chordae-papillary muscle apparatus
Mechanical valves require anticoagulation
tissue valves degenerate
all types prone to endocarditis
What is the most common cause of Mitral Stenosis?
Rheumatic Fever
What are the 4 forms of MV stenosis?
Commisural
Cusps
Chordal
Combined
What are the conditions that mimic Mitral Stenosis?
Left atrial Myxoma
Left atrial ball-valve thrombus
infective endocarditis with large vegitations
cor triatrium (congenital)
What happens to the Diameter of the Mitral Valve in Mitral Stenosis?
Normal 4-6cm2
1-2 cm sq or less
What is seen in the history of Mitral Stenosis?
Systemic EMBOLIZATION
Endocarditis
Chest Pain
Hemoptysis
What are the points of Virchow’s Triad of intrathelial/Intracardial embolization?
Stasis of Flow
Hypercoaguable state
Endothelial Injury
What is seen on PE of Mitral Stenosis?
Mitral Facies: Purple-pink cheeks
Arterial pulses reduced?
Apical pulse is inconspicuous to absent
What is Auscultated in Mitral Stenosis?
S1 is LOUD
Opening Snap
Diastolic Murmur of MS
Duration of murmur correlates with degree of stenosis
Grahm Steel Murmur
Tricuspid Murmur
What will imaging show in Mitral Stenosis?
CXR LA enlarged
ECHOCARDIOGRAPHY Thickened or calcified MV leaflets separate poorly in diastole Inc LA size Thrombus in LA appendage HOCKEY STICK SIGN
Doppler techniques can delineate MR, AR, other valve lesions
What is seen on ECG in Mitral Stenosis?
Left atrial Abnormality of P wave with a divot(double bump mitral). II and V1
Deep terminal P force in V1
What is different about prevalence of Mitral Stenosis in Tropical Climates?
MS is seen in children
What is Tx of Mitral Stenosis
Prophylaxis against infective endocardiitis and B hemolytic Strep Avoid strenuous activity Anticoagulants for prophylaxis against emboli (esp stroke) BEFORE CARDIOVERSION Maint Sinus Rhythm Reduce salt and Water intake DO NOT Become pregnant Beta Blockers