Y2B2B Cs- Mitral Valve Disorders

Front 1

what is the most common cause of mitral stenosis? what is the pathophysiology of this cause?

Back 1

Rheumatic fever

Rheumatic fusion at tips: calcific fusion from cusps. As soon as the valve seals, those inflammed tips touch and get stickier and stickier and at some point they start to fuse and can’t pull apart. This is different from calcification which starts at the base and grows towards the tips.

Front 2

what are the etiologies of mitral stenosis?

Back 2

Rheumatic fever

others; degenerative calcific disease- seen in elderly
connective tissue disorders (SLE, RA)
congenital

Front 3

what is the overall pathophysiology of mitral stenosis?

Back 3

gradient develops --> atrial pressure increases --> left atria --> lungs --> pulmonary HTN--> can impair RV function leading to cor pulmonale

Left atrial dilation --> atrial fibrillation

Front 4

what is the LV pressure in mitral stenosis?

Back 4

it is normal because there is nothing wrong with the LV. The problem is getting the blood from the atrium into the ventricle, not the ventricle itself.

Front 5

what is the biggest clinical sx of mitral stenosis?

Back 5

SOB--> exertional dyspnea/ orthopnea

Front 6

what type of murmur is associated with mitral stenosis?

Back 6

diastolic low pitched apical murmur -->decrescendo sound- low pitch murmur. Sounds like a rumble.

Front 7

what sounds will you hear on auscultation w/ someone who has mitral stenosis d/t rheumatic disease?

Back 7

opening snap after S2 before murmur and S1 will be loud

Front 8

what can you feel in a pt who has mitral stenosis?

Back 8

RV heave, normal PMI and fxn.

Front 9

what would you see on an CXR of mitral stenosis? what about echo?

Back 9

CXR: large RV, pulmonary vascular engorgement, large left atrium.
echo: thickened, fused leaflets on eacho

Front 10

what is the nonsurgical therapy for mitral stenosis?

Back 10

-diuresis for acute pulm edema
-anti-arrhythmics where indicated
-B-blockers
-Digoxin
-oral anticoagulants
-antibiotic prophylaxis

Front 11

what surgeries can you do for mitral stenosis? which one is the best choice?

Back 11

Balloon valvuloplasty--> will stay open for years
open commissurotomy
valvular replacement-- best choice

Front 12

what is the aim of surgery in a pt with mitral stenosis?

Back 12

to prevent irreversible pulmonary HTN.

Front 13

for Mitral stenosis ___ years to progress from mild to severe

Back 13

5

Front 14

what are the etiologies associated w/ mitral regurgitation?

Back 14

leaflet destruction (infection, calcific degen, connective tissue dz, trauma)
myxomatous degenertaion
papillary muscle dysfunction
dilated cardiomyopathy
hypertrophic cardiomyopathy

Front 15

what is the nonsurgical therapy for mitral stenosis?

Back 15

-diuresis for acute pulm edema
-anti-arrhythmics where indicated
-B-blockers
-Digoxin
-oral anticoagulants
-antibiotic prophylaxis

Front 16

what surgeries can you do for mitral stenosis? which one is the best choice?

Back 16

Balloon valvuloplasty--> will stay open for years
open commissurotomy
valvular replacement-- best choice

Front 17

what is the aim of surgery in a pt with mitral stenosis?

Back 17

to prevent irreversible pulmonary HTN.

Front 18

for Mitral stenosis ___ years to progress from mild to severe

Back 18

5

Front 19

what are the etiologies associated w/ mitral regurgitation?

Back 19

leaflet destruction (infection, calcific degen, connective tissue dz, trauma)
myxomatous degenertaion
papillary muscle dysfunction
dilated cardiomyopathy
hypertrophic cardiomyopathy

Front 20

what is the pathophysiology of mitral regurgitation?

Back 20

blood in LV --> atrium --> worse in systemic afterload --> left atrial pressure and pulmonary wedge pressure rise -> atrium dilates --> LV dilates to accommodate increased filling volume --> contractility decreases--> pulmonary HTN and edema ensue

Front 21

the symptoms of mitral regurgitation are the same as which other mitral valvular disease?

Back 21

Mitral stenosis--> SOB exertional dyspnea

Front 22

what extra heart beat is common in mitral regurgitation?

Back 22

S3

Front 23

what type of murmur is heard in mitral regurgitation? what does this help to differentiate?

Back 23

holosystolic murmur at apex. This is the differentiator between MR and aortic stenosis. Aortic stenosis has a crescendo-decrescendo murmur.

Front 24

where does the mitral regurgitation murmur radiate to?

Back 24

the back just below the scapula

Front 25

what would you feel on physical evaluation of a pt w/ mitral regurgitation?

Back 25

LV heave and laterally displaced PMI, as well as a full upstroke pulses.

Front 26

what would you see on CXR and echo in a pt w/ mitral regurgitation?

Back 26

CXR: LV dilation, LA dilation, pulmonary vascular engorgement
echo: LV and LA enlargement.

Front 27

what is the nonsurgical therapy for mitral regurgitation?

Back 27

-preload reduction for acute heart failure
-afterload reduction
-digoxin
- anti-arrhythmics
-antibiotic prophylaxis

Front 28

how is the nonsurgical therapy different for Mitral stenosis for mitral regurgitation?

Back 28

mitral regurgitation has am afterload reduction to improve forward flow
mitral stenosis has B-blockers to prevent tachycardia and oral anticoagulants

Front 29

what are the surgical options for mitral regurgitation?

Back 29

annuloplasty
valvuloplasty
valve replacement
coronary revascularization

Front 30

what is the goal of surgery in a pt w/ mitral regurgitation?

Back 30

prevent irreversible LV dysfunction

Front 31

what measurement of the end-diastolic LV dimensions or end-systolic dimension of LV are markers for significant LV dysfunction for a pt w mitral regurgitation?

Back 31

EDLV--> 7cm
ESLV--> 5 cm

Front 32

what does LVEF <40% indicate in a pt w/ mitral regurgitation?

Back 32

severe, possibly inoperable LV dysfunction

Front 33

what are the 3 etiologies of MVP?

Back 33

myxomatous degeneration of valve
genetically mediated
assoc w/ other dyscollagenoses

Front 34

high circulating ______ are associated with MVP

Back 34

catecholamines

Front 35

T/F

more likely to see sxs associated w/ MVP in men.

Back 35

true

although women get it 4x as many times, men are more likely to have sxs associated with it.

Front 36

what is the clinical presentation of MVP? when does this happen?

Back 36

chest pain, palpitations, exertional dyspnea, occasional syncope

-2nd or 3rd decade

Front 37

what would you hear on auscultation if the patient only had MVP? what happens if you put them in valsalva?

Back 37

early to mid systolic click at apex, if in valsalva this click will get loader.

Front 38

what is the therapy for MVP?

Back 38

reassurance.
B-blocker for sxs
antibiotic prophylaxis if murmur is present.