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10: Chronic Mitral Valve Insufficiency - Brown
Terms in this set (36)
What prevents the mitral valve from prolapsing?
Chordae tendinae attached to papillary muscles
What is underlying cause of mitral insufficiency d/t papillary muscle malalignment from LV dilatation?
CHF from severe systolic dysfunction
Dilated LV pulls papillary muscles apart so leaflets don't close
Why would mitral regurgitation improve from treating systolic CHF?
Would decrease size of ventricle so leaflets of valve close again
What are three main causes of mitral valve regurgitation?
Abnormalities of leaflets
What causes click in mitral valve prolapse?
Portion of valve connected to lengthened chordae snaps into place
What causes turbulance in mitral valve prolapse?
Why does sitting/standing/valsava increase duration of murmur?
Reduce size of LV
What does mitral valve prolapse sound like?
Click followed by blowing murmur
Abnormalities of leaflets in mitral valve regurgitation
Shortened - RHD
Redundant - myxomatous, prolapse
Defective - endocarditis
What is cause of ruptured chordae in mitral valve regurgitation?
Problems with papillary muscle in mitral valve regurgitation can be either dysfunctional/ruptured or malalignment. Explain causes of each.
Dysfunctional/ruptured - occurs because CAD
Malalignment happens because of LV dilatation in systolic heart failure
What cause dysfunctional papillary muscle mitral valve regurgitation?
MI causing persistent mitral insufficiency
Angina causing transient mitral insufficiency
what causes ruptured papillary muscle mitral valve regurgitation?
What causes mitral valve prolapse?
Myxomatous degeneration of leaflet
Likely AD genetic inh. with age-dp penetrance
CT beigns to sag and chordae get stretched out
Incidence of mitral valve prolapse
Why do auscultatory events change timing in response to intervention in mitral valve prolapse?
Interventions result in changes to LV volume
Reducing ventricular volume do what to sounds in mitral valve prolapse?
Reducing LV volume will enhance leaflet redundancy, hasten prolapse, and move click and murmur earlier in systole
Maneuvers that reduce LV volume
Maneuvers that increase LV volume
What is prognosis of mitral valve prolapse?
Majority are benign
Minority may develop:
-Progressive mitral regurg (acute/chronic)
-Sudden cardiac arrest - very rare
CXR in MVP
EKG in MVP
May have PVCs and nonspecific ST-T abnormalities
Echo in MPV
Check for aortic root dilatation looking for evidence of Marfan's
Only do at initial dx and if changes (don't repeat every year)
Murmurs heard in mitral regurgitation
Start with and/or end with S1 and S2
Heard best at apex
Radiate to axilla
What causes murmur in mitral regurgitation?
Blood going back from LV into L atrium
What factors determine murmur and symptoms in pure mitral regurgitation?
Amt. of regurg.
Acute vs. chronic regurg.
LA compliance and size
Direction of mitral regurgitant jet into atrium
Patients with mitral insufficiency are dealing with a __________________ overload, which will cause ________________ of LV
Why is SV large in mitral insufficiency?
Because normal volume is going forward and a lot of it is regurgitating backward into LA
In addition to murmur, what other sound can be heard in mitral insufficiency?
S3 gallop (heard even in absence of systolic HF!)
What do we do when Pt starts experience symptoms from mitral insufficiency?
What do we call the murmur in chronic mitral insufficiency?
Blowing apical systolic murmur
Any movement of apical impulse in chronic mitral insufficiency?
Apical impulse moved out laterally
CXR of mitral valve insufficiency
Enlarged LV and LA
Minimal vascular congestion
What is blood pressure in chronic mitral valve insufficiency?
What is pulse in mitral valve insufficiency?
Normal or irregularly irregular if A-fib develops
Onset of sx in chronic mitral valve insufficiency
Onset of sx is long after onset of murmur
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