Mitral Valve Quiz

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Questions and Answers

Which patient category is indicated for mitral valve replacement?

Symptomatic patients with NYHA Class II symptoms

Asymptomatic patients with mild mitral stenosis

Symptomatic patients with NYHA Class III or IV symptoms (correct)

Asymptomatic patients with severe mitral regurgitation

What is a common complication associated with mitral stenosis?

Chronic heart failure

Atrial fibrillation (correct)

Acute myocardial infarction

Ischemic heart disease

What is the primary treatment for acute mitral regurgitation?

Increased diuretics to manage fluid overload

Afterload reduction with nitroprusside (correct)

Surgical valve replacement only

Beta-blockers to control heart rate

In chronic mitral regurgitation, what compensatory mechanism occurs due to volume overload?

Left ventricular hypertrophy and dilation Signup and view all the answers

Which condition is NOT a known etiology of chronic mitral regurgitation?

Hypertensive heart disease Signup and view all the answers

What is the primary cause of mitral stenosis in most cases?

Rheumatic heart disease Signup and view all the answers

What is considered a normal mitral valve area?

4-6 cm2 Signup and view all the answers

What condition can lead to right heart failure symptoms in mitral stenosis patients?

Pulmonary venous hypertension Signup and view all the answers

Which symptom is most commonly associated with mitral stenosis?

Dyspnea Signup and view all the answers

What event typically leads to the worsening of symptoms in mitral stenosis patients?

Increased physical activity Signup and view all the answers

What is a significant complication due to elevated pulmonary pressure in mitral stenosis?

Hemoptysis Signup and view all the answers

During which condition might functional mitral stenosis occur?

Rheumatic activity Signup and view all the answers

What is the potential progression timeline for severe mitral stenosis following the initial rheumatic heart disease insult?

10 years Signup and view all the answers

What position should a patient be in to best hear the diastolic murmur of mitral stenosis?

Lying on the left side Signup and view all the answers

Which characteristic does NOT correlate with the severity of mitral stenosis?

Intensity of the diastolic murmur Signup and view all the answers

What is the hallmark sound associated with mitral stenosis?

Opening snap Signup and view all the answers

In which imaging study is the mitral valve area best assessed?

Echocardiography (ECHO) Signup and view all the answers

What is a common ECG finding in patients with mitral stenosis?

Atrial fibrillation Signup and view all the answers

Which medication is NOT typically used to manage mitral stenosis?

Anticoagulants Signup and view all the answers

What does a shorter interval between S2 and opening snap indicate?

More severe disease Signup and view all the answers

What is a potential complication of mitral stenosis that can be monitored over time?

Atrial fibrillation Signup and view all the answers

What is the recommended management strategy for patients with mitral stenosis who are symptomatic and have a clear mechanical obstruction?

Percutaneous mitral balloon valvotomy Signup and view all the answers

Which type of imaging is least likely to show pathology in mitral stenosis?

Electrocardiography Signup and view all the answers

Which symptom is NOT associated with pulmonary venous congestion?

Cold extremities Signup and view all the answers

What physical sign indicates systemic venous congestion?

Lower limb swelling Signup and view all the answers

Which sign is characteristic of advanced right-sided heart failure?

S3 gallop Signup and view all the answers

What is the prominent 'a' wave in jugular venous pulsations indicative of?

Pulmonary hypertension Signup and view all the answers

Which finding is associated with increased left ventricular pressure at the time of mitral valve closure?

Accentuated S1 Signup and view all the answers

The diastolic murmur of pulmonary regurgitation, known as Graham steel murmur, is best heard at which location?

Left sternal border Signup and view all the answers

What symptom is associated with low cardiac output?

Dizziness Signup and view all the answers

Which of the following is NOT a sign of mitral stenosis?

Kussmaul's sign Signup and view all the answers

Which symptom could result from compression of the left recurrent laryngeal nerve?

Hoarseness of voice Signup and view all the answers

What physical examination finding would indicate the presence of functional tricuspid regurgitation?

S3 gallop Signup and view all the answers

Study Notes

Valvular Heart Disease Overview

The presentation covers valvular heart disease, focusing on mitral valve stenosis and regurgitation.
Mitral stenosis is the narrowing of the mitral valve, hindering blood flow.
Mitral regurgitation involves blood leaking backward through the mitral valve during the heart's pumping cycle.
Mitral valve lesions, stenosis and regurgitation, worsen with increasing severity, leading to various symptoms.
Acute mitral regurgitation or stenosis requires rapid diagnosis and treatment.

Intended Learning Objectives

The objectives cover essential aspects of valvular diseases, including:
- Understanding common causes.
- Recognizing signs, symptoms.
- Diagnosing and treating acute regurgitation/stenosis.
- Identifying patients for surgical valve replacement and post-procedure follow-up.

Overview

The presentation highlights mitral stenosis, mitral regurgitation, and distinctions between acute and chronic forms.

Etiology of Mitral Stenosis

The most common cause of mitral stenosis is rheumatic heart disease (77-99%).
Other etiologies include infective endocarditis (3.3%) and mitral annular calcification (2.7%).

Mitral Valve Anatomy

A labeled diagram presents the key anatomical components of the mitral valve.

Mitral Stenosis Overview

Mitral stenosis obstructs blood flow from the left ventricle (LV) to the left atrium (LA) during diastole.
Normal mitral valve area ranges from 4-6 cm².
Symptoms emerge when the mitral valve area narrows below 2 cm².

Mitral Regurgitation Pathophysiology (MR)

Chronic mitral regurgitation (MR) results in blood flowing backward from the left ventricle to the left atrium during systole.
Mild mitral regurgitation is common (present in 80% of normal individuals)

Etiology of Acute MR

Acute mitral regurgitation can stem from infective endocarditis.
Acute myocardial infarction can trigger acute mitral regurgitation.
Malfunction of a prosthetic valve is another potential cause.

Management of Acute MR

Beta-blockers are not usually useful for managing tachycardia in acute MR.
Diuretics and vasodilators such as nitroprusside are often used for acutely ill patients with heart failure related to severe mitral regurgitation
Surgical treatment (balloon pump or emergent surgery) often becomes necessary for severe acute cases.

Mitral Regurgitation Pathophysiology

Pure volume overload is a key characteristic as blood backs up from the left ventricle.
Compensatory processes like left atrial and left ventricular hypertrophy initially help the heart cope.
Progressive left ventricular dilation and right ventricular dysfunction from pulmonary hypertension eventually occur.

Physical Examination Findings in MR

A soft S1 and a holosystolic murmur radiating to the axilla are common findings.
An S3 (CHF/LA overload) might be present, and the murmur intensity often correlates with severity.
Exertion dyspnea (exercise intolerance) and signs of heart failure (e.g., pregnancy, infection or atrial fibrillation) are frequently seen.

Natural History of MR

Patients often have a compensatory phase of 10 -15 years.
5%/year mortality can occur if the effective ejection fraction (EF) drops below 60%.
Mortality increases sharply once symptoms develop.

Imaging Studies for MR

ECG may show left atrial (LA) enlargement.
CXR can reveal LA enlargement or central pulmonary artery enlargement.
Echocardiography (ECHO) is crucial to evaluate mitral valve structure, assessing left atrium (LA), left ventricle (LV) size, and function.
Transesophageal echocardiography (TEE) is sometimes used if transthoracic ECHO is inconclusive.

Grading of MR Severity

A table outlines the qualitative and quantitative methods for grading the severity of mitral regurgitation, considering various metrics (e.g., vena contracta width).

Management of MR (Medications)

Vasodilators (e.g., hydralazine)
Rate control for atrial fibrillation using beta-blockers, calcium channel blockers or digoxin
Anticoagulation (especially for atrial fibrillation or flutter).
Diuretics to manage fluid overload.

Management of MR (Prophylaxis)

IE prophylaxis is critical for patients with prosthetic heart valves or a history of infective endocarditis (IE).
It is important to ensure timely prophylactic intervention, especially for high-risk patients likely to need procedures requiring oral/dental hygiene or procedures involving mucous membranes.

Simplified Indications for MV Replacement

Any symptomatic patient with NYHA Class III or IV symptoms.
Asymptomatic individuals with moderate or severe MS that isn't suitable for percutaneous balloon valvotomy, or significant EF <60% and/or new onset atrial fibrillation.

Pretest Questions

Students are asked to prepare before the lecture, considering mitral valve functions, location, diseases, and management strategies.

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Description

Test your knowledge on mitral valve conditions, including indications for replacement and complications associated with mitral stenosis. This quiz covers key treatment approaches and mechanisms related to both acute and chronic mitral regurgitation.