65 Questions
Which chamber does the mitral valve connect?
Left atrium and left ventricle
When does the mitral valve open?
During diastole
What is the most common cause of mitral stenosis?
Rheumatic fever
What are the typical characteristics of mitral valve leaflets in patients with mitral stenosis?
Thickened and fused
What is the function of the mitral valve during systole?
Prevents backflow to the left atrium
What is the natural history of mitral stenosis typically like?
Progressive acceleration in later years
Which medication is used for rhythm control in atrial fibrillation?
Amiodarone
What is the primary prophylaxis for the prevention of rheumatic fever?
Treatment of streptococcal pharyngitis
How long does secondary prevention continue in patients with carditis?
10 years
What complication is associated with mitral stenosis?
Pulmonary edema
Which condition is NOT a common cause of mitral regurgitation?
Atrial fibrillation
What causes acute mitral regurgitation?
Mitral valve prolapse
What is the primary etiology of chronic primary mitral regurgitation?
Degenerative mitral valve disease
What is the most common cause of acquired mitral valve disease in the Western world?
Mitral valve prolapse
What is the pathophysiology of chronic decompensated mitral regurgitation?
Progressive dilation of the left ventricle
What is the prognosis of patients with acute regurgitation?
Cardiogenic shock and acute pulmonary edema
What causes MVP (mitral valve prolapse)?
Myxomatous degeneration
What complication can occur due to balloon valvulotomy in mitral stenosis?
Increased left atrial pressures
What is the definitive treatment for mitral regurgitation?
Mitral valve replacement
What is the primary aim of medical treatment for acute primary MR?
To improve forward flow
Which medication is used to reduce preload and the left ventricular volume?
Furosemide
What should not be attempted to alleviate in patients with mitral regurgitation?
Tachycardia
In which condition should cardioversion be considered for patients with mitral regurgitation?
Rapid atrial fibrillation
Which surgical treatment is considered the optimal choice for mitral regurgitation?
Mitral valve repair
What is the mortality rate for patients with acute mitral regurgitation secondary to infarction requiring valve replacement and presenting with severe pulmonary edema?
> 60%
Which complication is not a major complication from chronic regurgitation?
Ruptured chordae tendineae
What type of approach is used for transcatheter mitral valve interventions?
Transseptal approach
What is the primary aim of vasodilators in the management of acute heart failure?
To reduce afterload
Which condition is an indication for surgical treatment of chronic primary MR?
Symptomatic patients irrespective of LV systolic function
Which medication should be used to manage rapid atrial fibrillation secondary to chronic mitral regurgitation?
Digoxin
What is the most common cause of mitral stenosis?
Rheumatic fever
What is the normal area of the mitral valve orifice?
4-5 cm²
What occurs when the valve area is narrowed to less than 2.5 cm²?
Impedes the free flow of blood and increases left atrial pressure
At what stage does critical mitral stenosis occur?
When the opening is reduced to 1 cm²
What is the 10-year survival rate of untreated patients with mitral stenosis?
50-60%
Where is the prevalence of rheumatic fever and mitral stenosis higher?
Developing nations
Which factor contributes to the decrease in the prevalence of mitral stenosis?
Antibiotic treatment of strep throat
What is the gender difference in the prevalence of mitral stenosis?
2-3 times more common in women
Which condition is NOT a cause of mitral stenosis?
Pulmonary tuberculosis
What might be present on physical examination of a patient with stenotic mitral valve?
Palpable systolic thrill
Which symptom is commonly associated with mitral stenosis?
Exertional dyspnea and orthopnea
What might be a consequence of chronic elevation of pulmonary capillary pressure in mitral stenosis?
Decreased stroke volume
What is the diagnostic study of choice for mitral stenosis?
Two-dimensional and Doppler echocardiography
Which imaging technique provides better images of the mitral valve and is a more sensitive way to detect pathology such as valvular vegetations or atrial thrombus?
Transesophageal echocardiography (TEE)
Which characteristic findings are associated with imaging studies of mitral stenosis?
Reduced mitral valve area (MVA)
What is the most accurate noninvasive technique to quantify the hemodynamic severity of mitral stenosis?
Doppler echocardiography
What does an ECG in a patient with significant mitral stenosis and sinus rhythm typically display?
Left atrial enlargement
Which procedure is indicated when a discrepancy exists between Doppler-derived hemodynamics and the clinical status in a symptomatic patient?
Cardiac catheterization
What is the initial procedure of choice for symptomatic patients with moderate-to-severe mitral stenosis?
Percutaneous mitral balloon valvotomy
What intervention is recommended for patients with NYHA FC III-IV symptoms, moderate or severe mitral stenosis, and valve morphology favorable for repair or replacement?
Surgical intervention
What is recommended for patients with moderate or severe mitral regurgitation?
Mitral valve repair or replacement
What does pregnancy cause in patients with mitral stenosis?
Increase in cardiac output
What is the most commonly successful way to convert atrial fibrillation to sinus rhythm?
Brief duration of atrial fibrillation (< 6-12 months) and not severely dilated left atrium
What therapy are medications directed at for mitral stenosis?
Reducing the incidence and severity of symptoms and complications
Which symptom is most likely to be present in patients with chronic mitral regurgitation?
Dyspnea and fatigue progressing to orthopnea and paroxysmal nocturnal dyspnea
What is a common complication associated with left atrial enlargement in patients with chronic mitral regurgitation?
Atrial fibrillation
What is a characteristic physical finding in patients with severe chronic mitral regurgitation?
Apex beat laterally displaced with cardiomegaly
What is the most likely physical examination finding in acute mitral regurgitation?
Late inspiratory crackles and bibasilar fine crackles
What imaging study is used to confirm the diagnosis of mitral regurgitation?
Two-dimensional echocardiography
What is a common finding in the electrocardiogram (ECG) of patients with chronic mitral regurgitation?
Evidence of left ventricular hypertrophy and left atrial enlargement
What is a common symptom in patients with MVP syndrome?
Atypical chest pain and anginal-type pain
Which imaging study provides a better estimate of the severity of damage in mitral regurgitation?
Transesophageal echocardiography
What is a common finding in the electrocardiogram (ECG) of patients with MVP?
ST- and T-wave changes with T-wave inversions in the inferior leads
What is a characteristic physical finding in patients with MVP syndrome?
Presence of mid-to-late systolic click and a late systolic murmur
What is the most likely physical examination finding in chronic mitral regurgitation?
Constant systolic ejection murmur with a third heart sound
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