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Flashcards in Valvular heart disease - ND Deck (21)
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1
Q

Which side of the heart is the mitral valve on?

A

Left

Between left atrium and ventricle

2
Q

What is mitral stenosis?

A

Thickening of the mitral valve causing the size of the opening to decrease

3
Q

What are the causes of mitral stenosis?

A

Rheumatic heart disease (chronic)

Congenital MS

Systemic conditions:

  • systemic lupus erythematosus
  • rheumatoid arthritis
4
Q

How small does the mitral orifice need to be before it is stenosed?

A

< 2cm^2

5
Q

What is the effect of mitral stenosis on the CVS?

A

A-V pressure gradient increases

Left atrial pressure increases

Pulmonary venous & capillary pressure increases

Pulmonary Vascular Resistance increases

Pulmonary artery Pressure increases & Pulmonary Hypertension develops

Right heart dilation with Tricuspid regurgitation & Pulmonary Regurgitation

6
Q

What remains normal despite mitral stenosis?

A

Left Ventricle pressures
Systolic function

(basically the Left ventricle is fine)

7
Q

Mitral stenosis affects the Trans-valvular pressure gradient & trans-valvular flow rate

How is flow affected overall?

A

In order to maintain cardiac output, heart rate must increase - tachycardia

Tachycardia has secondary effects on:

  • Exercise
  • Acute illness
  • Pregnancy
  • Atrial fibrillation (irregular fast heart beat)
8
Q

Describe the clinical manifestations of mitral stenosis

A

Dyspnoea: can be mild exertional to pulmonary oedema

Haemoptisis

Systemic embolisation: enlargement of left atrium & left atrial appendage

Infective endocarditis

Chest pain

Hoarseness

9
Q

What causes haemoptisis in a patient with mitral stenosis?

A

Rupture of thin walled veins

10
Q

What causes hoarseness of the voice in a patient with mitral stenosis?

A

Compression of the Left recurrent laryngeal nerve

11
Q

Describe the signs on examination, of a patient with mitral stenosis

A

Mitral facies

Normal pulse

JVP - prominent ‘a’ wave

Tapping apex beat & diastolic thrill

Right ventricular heave

Auscultation:

  • Snapping after 2nd heart sound
  • Murmur after Snap until mid diastole
12
Q

What is Mitral facies?

A

Facies = facial expression/look associated with a condition

Mitral facies:

  • Rosy cheeks
  • Rest of face is cyanosed
13
Q

What are the investigative techniques for mitral stenosis?

A

ECG
Cardiac catheter

Chest radiograph
Echocardiography
Cardiac Magnetic resonance

14
Q

How would an ECG indicate mitral stenosis?

A

P wave > 0.12s

= RVH

15
Q

Why is a chest radiograph useful for diagnosing mitral stenosis?

A

One of the effects of mitral stenosis is enlargement of the left atrium

LA enlargement visible on CXR

16
Q

Why is echocardiography a useful imaging technique for mitral stenosis?

A

Shows thickening & scarring of the leaflets

and Fusion of the commissures

17
Q

Treatment for mitral stenosis involves both pharmalogical & interventional management

What groups of drugs are used to treat mitral stenosis?

A

Diuretics & drugs to restrict intake of Na+

Atrial fibrillation: drugs to restore Sinus rhythm or control ventricular rate

Anticoagulants

18
Q

What interventional options are used to treat mitral stenosis?

A

Valvotomy (balloon or surgical)

Mitral valve replacement

19
Q

What are the causes of mitral regurgitation?

A

Rheumatic heart disease
Mitral valve prolapse (MVP)
Infective endocarditis
Degenerative diseases

Left ventricular & annular dilation causes functional MR

20
Q

What is annular dilation?

A

Dilation of the annulus (collagen ring things) surrounding the valve

The greater the annular enlargement - the larger the regurgitation

21
Q

What is the difference between acute & chronic mitral regurgitation?

A

Difference in the way the left ventricle deals with the MR:

Acute:

  • End systolic pressure & volume decrease
  • Wall tension decreases

Chronic:

  • End diastolic volume increases and ESV returns to normal
  • Eccentric Left ventricular hypertrophy develops