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Cardiovascular system SA > Valvular heart disease - Mitral > Flashcards

Valvular heart disease - Mitral Flashcards

1
Q

What valve is made up only of two leaflets

A

Mitral valve

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2
Q

What is the AV valves strongly connected too

A

The left ventricle though the papillary muscle

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3
Q

What is the aetiology of mitral stenosis

A

Rheumatic Heart Disease - most common

Congenital MS (born with it) - rare

Systemic lupus erythematosus - autoimmune disease that affects the healthy tissue

Infective endocarditis

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4
Q

When would you call it mitral valve stenosis

A

When the mitral valve is less than 2cm

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5
Q

What is the normal span for a mitral valve

A

4-6cm

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6
Q

What is the pathophysiology occurring when the mitral valve narrows and causes pulmonary hypertension

A

The pressure gradient between the atrium and the vertical increases,
left atrium build up backtracks to pulmonary circulation to the right side of the heart creating pulmonary hypertension
resulting in right heart dilation

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7
Q

What heart chamber suffers in mitral stenosis

A

Left atrium

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8
Q

What affect does mitral stenosis have on the left ventricle

A

Left ventricle pressure and systolic function normally

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9
Q

What affects the severity of mitral stenosis

A

Transvalvular pressure gradient and flow rate

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10
Q

What condition branching of mitral stenosis make it easier to clingy diagnose mitral stenosis

A

When tachycardia occurs as other signs and symptoms accompany

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11
Q

What is the symptoms of mitral stenosis

A 
Dyspnoea: 
Haemoptisis 
Chest pain
Hoarseness
palpitations
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12
Q

What causes the dyspnoea in mitral stenosis

A

Pulmonary oedema - accumulation of blood

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13
Q

What causes haemoptisis in mitral stenosis

A

rupture of thin-walled veins due to increased pressure

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14
Q

What causes hoarseness in mitral stenosis

A

Left atrium enlarges so much that is compresses the recurrent laryngeal nerve

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15
Q

What causes the systemic embolisation in mitral stenosis

A

Left atrium enlargement

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16
Q

What is the clinical signs in mitral stenosis examination

A 
Mitral facies - discolouration of nose and cheeks 
Pulse – normal
JVP – prominent a wave
Tapping apex beat and diastolic thrill
RV heave

Auscultation:
Diastole murmurs (blow)
S3

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17
Q

Why is the pulse normal in mitral stenosis

A

As the left ventricle is normal

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18
Q

Why is the a wave more prominent in JVP

A

as pressure is higher on the right side of the heart

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19
Q

What is signs the mitral stenosis is severe

A

A longer right ventricle heave

Loud murmur

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20
Q

Why can you hear a third heart sound in mitral stenosis auscultation

A

mitral valve opening because of the pressure

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21
Q

What investigations are used for mitral stenosis

A 
ECG 
catheritisation 
Chest x ray
Cardiac Magnetic Resonance
Echocardiography
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22
Q

On a ECG how do you measure mitral stenosis severity

A

Greater P wave or R wave on an ECG the greater the atrial ventricular gradient and severity

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23
Q

What does a chest x ray show

A

If there if a left atrium enlargement

24
Q

What is best used for diagnosis of mitral stenosis

A

Echocardiography

25
Q

What does a Echocardiography allow you to see in diagnosis of MS

A

Thickening and scarring of the leaflets
Fusion of the commissures (valves)
the difference in rest and exercise

26
Q

What does cardiac magnetic resonance show in mitral stenosis investigations

A

Shows pressure gradient

Shows if valve is open or not

27
Q

What is the medical treatment of mitral stenosis

A

Diuretics
restriction of Na intake
Valvotomy (balloon vs surgical)
Mitral valve replacement/repair

28
Q

What medical treatment treats atrial fibrillation in mitral stenosis

A

anticoagulation

29
Q

What is the aetiology of Mitral Regurgitation

A 
Rheumatic Heart Disease
Mitral valve prolapse (MVP)
Infective endocarditis 
Degenerative
LV and annular dilatation
30
Q

What occurs in mitral valve prolapse

A

Occurs later in life in middle aged men, chordae tendinae snap, valves no longer anchored so parachute upwards - therefore leak

31
Q

What occurs in degenerative heart disease

A

Tissue become thicker due to slow calcification of mitral valves - become fibrotic

32
Q

What can potentially cause left ventricle enlargement

A

Previous heart attack

33
Q

What is the affect of left ventricular enlargement on the mitral valve

A

Stretches the two cusps of the mitral valve apart

34
Q

What is effective regurgitant orrifice of mitral regurgitation dependant upon
(the leakiness of the valves)

A

Preload,
After-load,
Left ventricle contractility

35
Q

Why doesn’t ventricular compensation occur in acute mitral regurgitation and therefore what happens

A

Ventricles struggle to adapt as chordae has just snapped
and no mechanism has been put in place

end-systolic pressure and end-systolic volume decreases which in turn decreases wall tension

36
Q

What occurs as a result of left ventricular compensation in chronic mitral regurgitation

A

The ventricles adapt to pressure and volume changes and usually contract more forcefully and dilate
therefore increasing end diastolic volume allowing room for extra volume and pressure as compensation to MR

37
Q

What is the symptoms of mitral regurgitation

A

Dysnopea

Fatigue

38
Q

What is the clinical manifestations of acute and chronic mitral regurgitation

A

acute
Pulmonary oedema
cardiogenic shock

Chronic 
Ventricle dilation 
Right heart failure 
Atrial fibrillation 
Pulmonary hypertension
39
Q

Whats is the pathophysiology in left atrium compliance in mitral stenosis

A

Thickening of atrial myocardium increase pulmonary Ventricular Resistance resulting in pulmonary hypertension

Increase in volume mean less changes in pulmonary vasculature leading on to the development of atrial fibrillation

40
Q

What can be found on clinical signs and symptoms of mitral regurgitation

A

Pulse – normal
Brisk and hyperdynamic apex beat
RV heave
palpitations

Auscultation:
-loud systolic murmur

41
Q

What is the signs of right heart failure due to mitral regurgitation

A

Prominent JVP

Reduced pulse rate

42
Q

What clinical investigations take place for mitral regurgitation diagnosis

A 
ECG 
CXR
Cardiac catherisation
echocardiography 
Cardiac magnetic resonance
43
Q

What does ECG show in mitral regurgitation

A

will show enlargement of the right atria/ventricle

– bigger P wave/more prominent R wave

44
Q

What does a CXR show in mitral regurgitation

A

will show abnormal enlargement of the heart /LA enlargement/calcification

45
Q

What does a cardiac catherisation show in mitral regurgitation

A

LV angiography

46
Q

What does a echocardiography show in mitral regurgitation

A 
Left ventricle dimensions 
shows leaflet dysfunction
ventricle compensation (contractility ) 
chordae/ papillary muscle dysfunction
shows annular disease 
Basically shows severity of MR
47
Q

What does cardiac magnetic resonance show in mitral regurgitation

A

shows the cardiac volumes hence gives indication of ventricle compensation due to mitral regurgitation

48
Q

What is the medical treatment for acute mitral regurgitation, what is the outcome of this treatment

A

give patients diuretics and vasodilator

reduce preload/afterload and increase contraction of ventricle

49
Q

What is the medical treatment of chronic mitral regurgitation

A

Diuretics

Aim to conserve valve

50
Q

What surgical treatment can be performed on mitral regurgatation

A

Repair or replacement

51
Q

What is mitral annulus

A

a fibrous ring that is attached to the mitral valve leaflets.

52
Q

What does annular dilation result in

A

Annular dilatation can result in poor leaflet apposition, leading to functional mitral regurgitation.

53
Q

When is surgery recommended in mitral stenosis

A

when MVA and ECHOs <1.5cm

54
Q

What is severe MR in ECHO characterised by

A

systolic blood flow reversal in pulmonary veins

55
Q

What is the clinical manifestations of mitral stenosis

A

Right heart dilation:
Pulmonary hypertension

Left atrium enlargement

atrial fibrillation

Infectious endocardtits
(more prone to infection)

Systemic embolisation

Pulmonary oedema

Cardiovascular system SA (43 decks)

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