Dec 24, 2015
Aetiology
*MVP { Myxomatous mv } ,commonest in developed world
* Damage to the cusps :
_ RVD _ IE _ Congenital Cleft MV
* Damage to chordae:
_ RVD _ IE _ Trauma _ Degenerative
* Damage to papillary muscles :
_ Ischaemia _ Infarction _ Infiltrative _ HCM
* Damage of MV annulus:
_ Calcification _ IE { abscess }
* Dilatation of MV ring :
_ IHD _ CMP _ acute RV
Lv volume OL…. LV dilatation maintain normal COP later..…
LV decompensate LVEDP rise LV wall tension increase……
LV fail ….. pulmonary congestion….PH ……CHF
LV dilatation ….dilated MV ring…. > MR
Back pressure ….dilated LA …..AF … La thrombus ….. PHP ..
..…CHF …… thrombo-embolic phenomenon
Clinical features:
Symptoms :
_ Dyspnoea { pulmonary congestion }
_ Fatigue { low COP }
_ Palpitation { AF , increased stroke volume }
_ Oedema , Ascites { RVF }
_ Systemic embolization { stroke , ischaemic limb etc.. }
Signs:
_Pulse… Jerky .. AF..
_ Apex … Displaced hyperdynamic
_ Apical Pansystolic murmer +/_ Thrill …. 3rd HS
_ Signs of pulmonary congestion …{ crepitations , Pul. Oed. }
_ Signs of PH and RVF .. Loud P2 .. Lt.PS heave … Oedema…
Investigations:
* ECG … LAH , LVH ….AF
* Chest X-ray … LA enlargement … Pulmonary congestion..
… LV enlargement …Pulmonary oedema…
* ECHO …. Dilated LA and LV ….Dynamic LV…
.… Structural abnormalities of MV { e.g. MVP }
* Doppler … { CW … PW … color dopler .. }
_ Detects and quantifies MR_
* Cardiac catheterization …. Dilated LA and LV …. MR …
..… Assess PH…
..… Detect coexisting CAD …
Chest X-ray PA view
Management
Medical :
_ For mild and moderate cases
* Diuretic *Vasodilators , e.g. ACEI * Digoxin For AF
*Anticoagulant if AF *Antibiotic Prophylaxis against IE
Surgical :
* MV valvoplasty {Repair }
*MV replacement
Indications:
_ Worsening symptoms _Progressive cardiomegaly
_ Deterioration of LV F EF <60% , LVEDD > 55
Indications for Surgery in Isolated ,Severe Chronic Indications for Surgery in Isolated ,Severe Chronic
MRMR **Emerging (minor criteriaEmerging (minor criteria))::
_ _ Any symptoms of heart failureAny symptoms of heart failure _Or sub optimal exercise tolerance test _Or sub optimal exercise tolerance test
_ _ Flail mitral leafletFlail mitral leaflet
_ _ Left atrial diameter >45mmLeft atrial diameter >45mm
_ _ Paroxysmal atrial fibrillationParoxysmal atrial fibrillation
_ _ Abnormal exercise end-systolic volume indexAbnormal exercise end-systolic volume index
or ejection fractionor ejection fraction
General information
_Most common cause of isolated MR
_ Occurs in 5% of adults
_ Most discovered at ages 20- 40
_ Affects women > men
_ MV “floppy” or incompetent
_ Caused by myxomatous changes
_ May occurs with marfan syndrome
_ Cordae may rupture
Clinical features
_ May be asymptomatic
_ Mid systolic click +/_ late systolic murmer or PSM
_ MR -- chronic , or acute {rupture CT}
_ CHF
_ Increased risk for :
* IE
* Arrythmias
* Increased risk of embolic stroke and TIA { small }
* Sudden death { rare }
Common Murmurs and Common Murmurs and Timing Timing (click on murmur to (click on murmur to playplay))
Systolic MurmursSystolic Murmurs
Aortic stenosisAortic stenosis
Mitral insufficiencyMitral insufficiency
Mitral valve prolapseMitral valve prolapse
Tricuspid insufficiencyTricuspid insufficiency
Diastolic MurmursDiastolic Murmurs
Aortic insufficiencyAortic insufficiency
Mitral stenosisMitral stenosis
S1 S2 S1