Mitral Valve Disease Lecture
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| Mitral Stenosis | show 🗑
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| show | Abnormal retrograde flow across the valve
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| show | both mitral stenosis and regurgitation
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| show | stenosis, regurgitation/insufficiency, combined valvular disease (both of the above)
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| Describe the structure of the normal mitral valve | show 🗑
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| What are the possible etiologies for mitral stenosis? | show 🗑
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| What is the most common cause of mitral stenosis? | show 🗑
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| How does mitral annular calcification lead to stenosis? | show 🗑
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| show | Mitral valve anatomically normal. Obstruction casued by extrinsic structure
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| show | Long term sequelae from acute rheumatic fever
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| show | collagen vascular disorder which occurs following group A beta hemolytic streptococcal infections (strep throat); develops after several weeks after acute strep infection; involves joints, heart, CNS
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| show | inflammation --> damage of collagen fibers + ground substance in connective tissue; thought to be mediated by cross reactivity of Ab against streptococcal membrane proteins and human tissue
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| How is rheumatic fever diagnosed? | show 🗑
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| What are the major criteria in the modified jones criteion for the diagnosis of acute rheumatic fever | show 🗑
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| What are the minor criteria in the modified jones criteion for the diagnosis of acute rheumatic fever | show 🗑
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| In rheumatic fever, how does carditis present? | show 🗑
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| In rheumatic fever, how does polyarthritis present? | show 🗑
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| show | Syndeham's chorea (aka St. Vitus's dance): choreiform activity with rapid uncoordinated, jerky movement of cae, hands, feet; thought to be caused by destruction of basal ganglions; resolves after several months of onset but may persist indefinitely
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| In rheumatic fever, how does sybcutaenous nodules present? | show 🗑
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| In rheumatic fever, how does erythema marginatum present? | show 🗑
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| Describe the changes in the heart + blood during the acute phase of rheumatic fever | show 🗑
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| Describe the changes in the heart + blood during the chronic phase of rheumatic fever | show 🗑
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| What would you expect to find on an echocardiograph of a patient with chronic rheumatic valvular disease? | show 🗑
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| What event casues the c-wave? | show 🗑
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| What event is associated with the v-wave? | show 🗑
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| show | Towards END of ventricular diastole, left atrial contraction occurs, creating a transient increase in lef-atrial pressure tracing
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| What hemodynamic changes do you see in patients with Mitral Stenosis? | show 🗑
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| What are the hemodynamic changes associated with chronic elevation in left aterial pressure on the rest of the cardiopulmonary system? | show 🗑
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| show | Dyspnea and cough, orthopnea, chest pain, hoarseness, peripheral edema, fatigue, systemic thromboembolism
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| show | Low CO: fatigue, exhaustion, weakness, tiredness; right sided failure edamn, hepatomegally, tricuspid insufficiency, cyanosis, large heart, mild jaundice, hoarseness
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| What symptoms of mitral stenosis develop as a result of post-capillary block? | show 🗑
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| show | Mild: decresendo diastolic rumble (due to turbulence) with possible pre-systolic accentuation (due to atrial contraction); moderate: pan-diastolic rumble; progressive decrease in A2 to opening snap interval (OS not normally heard); soft S1, louder P2
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| What is the Gorlin formula? | show 🗑
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| What conditions can lead to increased mitral valve gradients? | show 🗑
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| How is mitral stenosis treated? | show 🗑
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| show | Regulate oral fluid intake, restrict Na consumption; oral diuretics (furosemid); important in pregant women (increase in intravascular volume + CO)
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| show | Rate control and (when possible) restoration of sinus rhythm; IMPORTANT for patients with tachyarrhytmias due to decrease in diastolic filling period and loss of atrial kick-->insufficient CO
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| show | insert catheter into right atrium through venous sheath-->intratrial septum punctured using small needled catheter --> balloon on catheter advanced through to mitral valve area and inflated to increase area
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| Who are ideal candidates for balloon mitral valvuloplasty? | show 🗑
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| show | surgically separating mitral valve leaflets in regions of commissural fusion; done either on or off bypass
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| show | With either mechanical (metallic) or bioprosthetic (porcine or bovine)valve
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| What are the etiologies for mitral valve regurgitation? | show 🗑
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| How can mitral valve prolapse lead to mitral regurgitation? | show 🗑
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| How can rheumatic valvular disease lead to mitral regurgitation? | show 🗑
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| How can endocarditis lead to mitral regurgitation? | show 🗑
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| show | dilation of the mitral valve annulus and/or apical displacement of the mitral leaflet coatpation poin due to enlargement of the ventricular cavity
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| show | due to ischemically mediated papillary muscle dysfunction or (in infarction) papillary muscle rupture related to myocardial necrosis
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| show | rupture of the papillary muscles
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| How can systemic disease lead to mitral regurgitation? | show 🗑
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| Pathophysiology of acute Mitral Regurgitation | show 🗑
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| What changes do you expect to see in the left atrium with mitral regurgitation? | show 🗑
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| What changes are seen in pathophysiology of chronic MR? | show 🗑
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| What is the change you expect to see in the left-ventricular pressure-volume relationship in acute mitral regurgigration? | show 🗑
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| What is the change you expect to see in the left-ventricular pressure-volume relationship in subacute mitral regurgigration? | show 🗑
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| show | Left ventricle becomes increaseing dysfunctional during systole --> LV pressure rises --> congestive heart failure and CHRONIC DECOMPENSATED PHASE of mitral regurg.
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| show | Prominent V-waves (simultaneous filling of LA from lung and contracting LV); rapid y-descent due to augmented antegrade flow (due to increased atrial preload)
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| show | Best heard in 5th intercostal space in anteroaxillary line + radiation into axilla: Pan-or holosystolic murmur (S1-->slightly beyond A2), early dystolic rumble (with possible S3); murmur location can vary based on direction of jet
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| What is the cause of mitral valve prolapse? | show 🗑
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| show | Ventricle contracts --> redundant mitral valve leaflets bow/prolapse into atria --> inappropriate coaptation of leaflet tips
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| What auscultatory finding would you find in mitral valve prolapse? | show 🗑
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| How does the position of the mitral valve click change with systole? | show 🗑
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| show | Relieve pulmonary vascular congestion (DIURETICS); reduce peripheral vascular resistance to augment forward blood flow (VASODILATORS or if critically ill, SODIUM NITROPUSSIDE); intra-aortic balloon; surgical repair or replacement of mitral valve
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| How does an intra-aortic baloon pump work and why does it help patients in cardiogenic shock? | show 🗑
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| What is the definitive treatment for patients with mitral regurgitation? | show 🗑
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| What is the mechanism of action of sodium nitroprusside? | show 🗑
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| show | Pro: short half-life, easily titrated; Con: cyanide is metabolic byproduct, so monitor CN if used over long period of time
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| show | 1) diuretics to manage volume overload and 2) vasodilator therapy in patients with systemic hypertension (no definitive data on benefit of chronic vasodilator therapy in normotensive patients)
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| What are the surgical treatment options for patients with mitral valve prolapse? | show 🗑
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| show | Postoperative survival decreases as LV function decreases.
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| show | Rule of thumb: mitral valve surgery for patients with severe regurgitation PRIOR to patient developing significant symptoms or left ventricular dysfunction
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Created by:
karkis77
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