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23 Cards in this Set
- Front
- Back
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Causes of Mitral stenosis |
-rheumatic fever (immigrants) -calcification (elderly) -CT disorders (SLE, RA) -congenital |
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In critical mitral stenosis, the mitral valve opening is < __________ (normally 4-6 cm^2) |
< 1 cm^2 |
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What does mitral stenosis cause? |
gradient, raising atrial pressure pulmonary hypertension atrial dilation--> atrial fibrillation
*(normal LV, RV eventually impaired due to rising pulmonary artery pressure) |
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Mitral stenosis: clinical presentation |
-exertional dyspnea/orthopnea -hemoptysis w/ pulmonary hypertension -palpitations (atrial fibrillation) -thromboembolism -endocarditits -diastolic low pitched apical murmur -opening snap after S2, before murmur -S1 loud -RV heave |
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Mitral stenosis: Diagnositic Eval |
CXR: large RV, pulmonary vascular engorgement, large LA ECHO: thickened, fused leaflets ECG: atrial abnormaility, RVH Doppler: gradient & vavle R & L heart catheterization |
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Mitral stenosis: Tx option |
therapy: -diuresis (pulmonary edema) -maintain regular HR (anti-arhythmics, beta blockers, digoxin) -oral anticoagulants & antibiotic prophylaxis
Valve tx: -balloon valvuloplasty -open commisurotomy -valvular replacement * surgery to prevent irreversible pulmonary hypertension
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Mitral regurgitation (VERY bad) causes |
-infection (SBE) -calcification -CT disorder -Trauma -dilated cardiomyopathy (pulls papillary muscles away--> cant close valve) -hypertrophic cardiomyopathy |
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Mitral regurgitation or Myxomatous Degeneration is due to an inc in blood volume. What does this lead to? |
dilation of papillary muscle & enlarged ventricle & atria (BUT NO INCREASE IN STRENGTH= BAD) |
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Acute/chronic mitral regurgitation is worse, why? |
acute mitral regurgitation is worse bc there is no time for atria & ventricle adpation--> immediate pulmonary edema (hrs) |
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Mitral regurgitation: clinical presentation |
-dyspnea/orthopnea -palpitations & atrial fibrillation -R heart failure (end-stage) -S3 (volume overload) -holosystolic murmur at apex (radiates to back & left axilla) -laterally displaced PMI w/ enlargement -LV heave |
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Mitral regurgitation: Diagnostic/ Eval |
CXR: LV & LA dilation, pulmonary vascular engorgement Echo: LV & LA enlargement Doppler: identify/quantify regurgitant ECG: LAA, RVH, atrial fibrillation cardiac cath |
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Mitral Regurgitation: Tx options |
therapy: -reduce preload/afterload -maintain contractility/rhythm -antibiotic prophylaxis (prevent endocarditis) tx: -surgery (to prevent irreversible LV dysfunction-->symptoms, diastolic LV 7cm, systolic 5cm, LVEF (ej frac) < 40%) -annuloplasty -valvuloplasty (reshape mitral valve)(best) -valve replacement -coronary revascularization |
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______________, is assoc w. collagen disorders, much more common in females (20-30 yrs), congenital, mycamatous degeneration (valves get bigger w/ age, don't close tightly), can worsen & cause mitral regurgitation, assoc w high circulating catecholamines |
Mitral Valve Prolapse (MVP) |
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Mitral Valve Prolapse: clinical presentation |
-anginal chest pain -palpitations (w/o arrhythmias( -exertional dyspnea -syncope -systolic click at apex -systolic murmur if regurg |
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MVP: Diagnostic/ Eval |
-ECHO: prolapse -Doppler: regurgitation -Holter: arrhythmia |
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Although women are more likely to get MVP, if a male has it what will happen? |
progress more rapidly, more symptomatic |
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MVP: tx options |
-Beta-blocker (block catecholamines) -antibiotic prophylaxis (if murmur) -watch for progression (prophylaxis) |
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Systolic murmurs are associated w/ what |
aortic stenosis mitral regurgitation |
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Diastolic murmurs are associated w/ what |
aortic regurgitation mitral stenosis |
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_______ is a pressure problem that mostly effects the Left Ventricle |
Aortic stenosis |
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_______ is a pressure problem that mostly effects the Lungs |
Mitral Stenosis |
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______ is a volume overload problem that mostly effects the Left ventricle (mild effects) |
Aortic regurgitation |
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_______ is a volume overload problem that effects BOTH the lungs & the heart (stretching) (WORST effects) |
Mitral regurgitation |
