Valvular heart disease - Mitral

Question 1

What valve is made up only of two leaflets

Answer 1

Mitral valve

Question 2

What is the AV valves strongly connected too

Answer 2

The left ventricle though the papillary muscle

Question 3

What is the aetiology of mitral stenosis

Answer 3

Rheumatic Heart Disease - most common

Congenital MS (born with it) - rare

Systemic lupus erythematosus - autoimmune disease that affects the healthy tissue

Infective endocarditis

Question 4

When would you call it mitral valve stenosis

Answer 4

When the mitral valve is less than 2cm

Question 5

What is the normal span for a mitral valve

Answer 5

4-6cm

Question 6

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

Answer 6

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

Question 7

What heart chamber suffers in mitral stenosis

Answer 7

Left atrium

Question 8

What affect does mitral stenosis have on the left ventricle

Answer 8

Left ventricle pressure and systolic function normally

Question 9

What affects the severity of mitral stenosis

Answer 9

Transvalvular pressure gradient and flow rate

Question 10

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

Answer 10

When tachycardia occurs as other signs and symptoms accompany

Question 11

What is the symptoms of mitral stenosis

Answer 11

Dyspnoea: 
Haemoptisis 
Chest pain
Hoarseness
palpitations

Question 12

What causes the dyspnoea in mitral stenosis

Answer 12

Pulmonary oedema - accumulation of blood

Question 13

What causes haemoptisis in mitral stenosis

Answer 13

rupture of thin-walled veins due to increased pressure

Question 14

What causes hoarseness in mitral stenosis

Answer 14

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

Question 15

What causes the systemic embolisation in mitral stenosis

Answer 15

Left atrium enlargement

Question 16

What is the clinical signs in mitral stenosis examination

Answer 16

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

Question 17

Why is the pulse normal in mitral stenosis

Answer 17

As the left ventricle is normal

Question 18

Why is the a wave more prominent in JVP

Answer 18

as pressure is higher on the right side of the heart

Question 19

What is signs the mitral stenosis is severe

Answer 19

A longer right ventricle heave

Loud murmur

Question 20

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

Answer 20

mitral valve opening because of the pressure

Question 21

What investigations are used for mitral stenosis

Answer 21

ECG 
catheritisation 
Chest x ray
Cardiac Magnetic Resonance
Echocardiography

Question 22

On a ECG how do you measure mitral stenosis severity

Answer 22

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

Question 23

What does a chest x ray show

Answer 23

If there if a left atrium enlargement

Question 24

What is best used for diagnosis of mitral stenosis

Answer 24

Echocardiography

Question 25

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

Answer 25

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

Question 26

What does cardiac magnetic resonance show in mitral stenosis investigations

Answer 26

Shows pressure gradient | Shows if valve is open or not

Question 27

What is the medical treatment of mitral stenosis

Answer 27

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

Question 28

What medical treatment treats atrial fibrillation in mitral stenosis

Answer 28

anticoagulation

Question 29

What is the aetiology of Mitral Regurgitation

Answer 29

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

Question 30

What occurs in mitral valve prolapse

Answer 30

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

Question 31

What occurs in degenerative heart disease

Answer 31

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

Question 32

What can potentially cause left ventricle enlargement

Answer 32

Previous heart attack

Question 33

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

Answer 33

Stretches the two cusps of the mitral valve apart

Question 34

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

Answer 34

Preload, After-load, Left ventricle contractility

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

What is the symptoms of mitral regurgitation

Answer 37

Dysnopea | Fatigue

Question 38

What is the clinical manifestations of acute and chronic mitral regurgitation

Answer 38

acute Pulmonary oedema cardiogenic shock ``` Chronic Ventricle dilation Right heart failure Atrial fibrillation Pulmonary hypertension ```

Question 39

Whats is the pathophysiology in left atrium compliance in mitral stenosis

Answer 39

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

Question 40

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

Answer 40

Pulse – normal Brisk and hyperdynamic apex beat RV heave palpitations Auscultation: -loud systolic murmur

Question 41

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

Answer 41

Prominent JVP | Reduced pulse rate

Question 42

What clinical investigations take place for mitral regurgitation diagnosis

Answer 42

``` ECG CXR Cardiac catherisation echocardiography Cardiac magnetic resonance ```

Question 43

What does ECG show in mitral regurgitation

Answer 43

will show enlargement of the right atria/ventricle | – bigger P wave/more prominent R wave

Question 44

What does a CXR show in mitral regurgitation

Answer 44

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

Question 45

What does a cardiac catherisation show in mitral regurgitation

Answer 45

LV angiography

Question 46

What does a echocardiography show in mitral regurgitation

Answer 46

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

Question 47

What does cardiac magnetic resonance show in mitral regurgitation

Answer 47

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

Question 48

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

Answer 48

give patients diuretics and vasodilator | reduce preload/afterload and increase contraction of ventricle

Question 49

What is the medical treatment of chronic mitral regurgitation

Answer 49

Diuretics | Aim to conserve valve

Question 50

What surgical treatment can be performed on mitral regurgatation

Answer 50

Repair or replacement

Question 51

What is mitral annulus

Answer 51

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

Question 52

What does annular dilation result in

Answer 52

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

Question 53

When is surgery recommended in mitral stenosis

Answer 53

when MVA and ECHOs <1.5cm

Question 54

What is severe MR in ECHO characterised by

Answer 54

systolic blood flow reversal in pulmonary veins

Question 55

What is the clinical manifestations of mitral stenosis

Answer 55

Right heart dilation: Pulmonary hypertension Left atrium enlargement atrial fibrillation ``` Infectious endocardtits (more prone to infection) ``` Systemic embolisation Pulmonary oedema