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  • Mitral Stenosis and Mitral Regurgitation

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    Mitral stenosis and mitral regurgitation are valvular heart diseases that affect the mitral valve. Mitral stenosis involves a narrowing of the mitral valve opening, while mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to flow back into the left atrium. Common causes include rheumatic heart disease. Symptoms include breathlessness and coughing. Diagnosis involves echocardiogram, chest x-ray and electrocardiogram. Treatment depends on severity but may include medications, balloon valvuloplasty, valve repair or replacement.

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    Mitral stenosis and mitral regurgitation are valvular heart diseases that affect the mitral valve. Mitral stenosis involves a narrowing of the mitral valve opening, while mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to flow back into the left atrium. Common causes include rheumatic heart disease. Symptoms include breathlessness and coughing. Diagnosis involves echocardiogram, chest x-ray and electrocardiogram. Treatment depends on severity but may include medications, balloon valvuloplasty, valve repair or replacement.

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    270 views21 pages

    Mitral Stenosis and Mitral Regurgitation

    Uploaded by

    ash_wan88
    Mitral stenosis and mitral regurgitation are valvular heart diseases that affect the mitral valve. Mitral stenosis involves a narrowing of the mitral valve opening, while mitral regurgitation occurs when the mitral valve does not close properly, allowing blood to flow back into the left atrium. Common causes include rheumatic heart disease. Symptoms include breathlessness and coughing. Diagnosis involves echocardiogram, chest x-ray and electrocardiogram. Treatment depends on severity but may include medications, balloon valvuloplasty, valve repair or replacement.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 21

    MITRAL STENOSIS AND MITRAL

    REGURGITATION
    ASYRAF SAFWAN
    MITRAL STENOSIS
    •  Define as a valvular heart disease presented
    as narrowing of the orifice of the mitral
    valve of the heart.
    • Causes: rheumatic heart disease
    calcification of mitral valve
    congenital mitral stenosis
    Pathophysiology
    Fibrosis and
    Narrowing Restriction
    calcification of mitral
    of orifice of blood
    valve
    flow from
    Breathlessness, haemoptysis, left atrium
    cough. Crepitation, pleural
    effusion

    Left atrial Pulmonary


    hepertrophy and Left atrial
    venous
    dilatation pressure
    congestion
    rises
    Pulmonary
    Increased Right heart
    hypertension
    heart rate hypertrophy and
    (SOB, fatique,
    (exercise and dilation
    chest pain.
    pregnancy)
    Loud S2, RV
    may
    heave)
    percipitate
    symptoms

    Right heart failure


    Left atrial hypertrophy (ascites, ankle
    and dilatation with oeedema, raised JVP)
    stenotic mitral valve

    Atrial
    fibrillation
    (palpitation.
    signs of atrial Low cardiac output Left atrial
    fbrillation) (fatique) thrombosis and
    due to systemic
    progressive thromboembolism
    dilataion (stroke, ischemic
    limbs)
    Signs
    • Loud S1, tapping apex beat, opening snap, after
    S1 moving to S2 in severe case.
    • Low pitched mid diastolic murmur sometimes
    with thrill
    • Coexisting mitral regurgitation can cause mid
    diastolic murmur.
    • Tricuspid regurgitation in RV dilatation can cause
    systolic murmur in RV and waves in JVP.
    • There might be coexisting mitral regurgitation.
    Pic manouver:
    left lateral
    using bell
    Investigation
    • ECG:
    • Chest x ray
    • Echocardiogram
    • Doppler echocardiography:pressure gradient
    across mitral valve, pulmonary artery pressure,
    left ventricular function
    • Cardiac catheterization: assessment of coexisting
    coronary heart disease and mitral regurgitation
    RAD, tall R wave in V1-2 are all diagnostic features of RVH.  Biphasic P wave with a
    prominent negative component in V1 is good for left atrial enlargement.  The P wave
    is somewhat prominent in lead II suggesting right atrial enlargement as well.
    Normal cardiac size,
    but the left atrial
    appendage is
    prominent Main
    pulmonary artery
    segment is just
    outside the left
    border, indicating
    pulmonary
    hypertension.
    Enlargement of left
    pulmonary artery and
    right pulmonary
    artery are just
    modest. The
    horizontal fissure is
    visible, indicating
    collection of edema
    fluid in the fissure.
    The aortic knuckle
    (Ao) is also seen well..
    Mitral stenosis with left atrial dilatation. This figure shows a thickened
    mital valve arrow
    Management
    • Minor symptoms: medical treatment
    • Definitive treatment: balloon valvuloplasty,
    mitral valvotomy and mitral valve replacement.
    • Medically: anticoagulant
    antiarrhytmia
    diuretics
    antibiotics from infective
    endocarditis
    Mitral ballon valvuloplasty
    • Fulfill criteria to undergo this procedure
    – Significant symptoms, isolated mitral stenosis,
    no/trivial mitral regurgitation, mobile and non-
    calcified valves, LA contain no thrombus.
    • They need to be given antibiotic to prevent IE.
    • There is possibility of restenosis.
    Mitral Regurgitation
    • Defined as disorder of the heart in which the mitral valve does
    not close properly when the heart pumps out blood.
    • Aetiology: rheumatic heart disease
    mitral valve prolapse
    dilatation of the left ventricles and mitral valve rings
    (cardiomyopathy, Coronary Artery Disease)
    damage to cusp and chordae (IE, rhematic heart
    disease)
    damage to papillary muscle
    MI
    Mitral regurgitation acute

    chronic
    Increased left atrial
    pressure
    Displaced apex
    Ventricular
    beat
    hypertrophy

    Acute pulmonary
    oedema (Breathlessness,
    Atrial hypertrophy haemoptysis, cough.
    Crepitation, effusion)

    Pulmonary hypertension

    Right ventricular Right sided heart


    hypertrophy failure
    Signs
    • Pansystolic murmur that radiates to axilla with
    or without thrill
    • Soft S1 and may or may not be loud S3
    Investigation

    Tall R waves in V4 and V5 with down sloping ST segment depression


    and T wave inversion are suggestive of left ventricular hypertrophy
    (LVH) with strain pattern. 
    Left atrial hypertrophy
    P wave
    duration > 0.12s in
    frontal plane (usually
    lead II)

     Notched P wave in
    limb leads with the
    inter-peak
    duration > 0.04s 

     Terminal P negativity
    in lead V1 (i.e., "P-
    terminal force")
    duration >0.04s,
    depth >1 mm. 
    Parasternal long axis view.
    Left atrium is dilated (compare with aorta).
    Left ventricle is dilated (the dots on the left side are in centimeters).
    Moderate posterior directed mitral regurgitation jet seen.
    • CXR: Enlarged left atrium, enlarged left
    venticle, pulmonary venous congestion,
    pulmonary oedema
    • Echo: detects and quantifies regurgitation
    • Cardiac catheterisation: Dilated LA, dialted LV,
    mitral regurgitation, pulmonary hypertension,
    coexisting coronary heart disease
    Management
    • Medical treatment: Diuretics
    Vasodilators eg ACE
    inhibitors
    Digoxin as antiarrhythmics
    Anticoagulants
    antibiotics as prophylaxis
    from IE
    • Surgical management: mitral valve repair
    (annuloplasty ring)
    mitral valve
    replacement
    Annuloplasty Ring
    • common cause of severe mitral regurgitation is
    caused by damage to chordae tendinae.
    • When the cordae are damaged, one or more of the
    leaflets that make up the mitral valve prolapse.
    • Then, repair the leaflet by using a new support
    system (new chords made of GoreTex) or by
    removing the weakened part of the leaflet and
    closing it up.
    • Then annuloplasty ring is implanted round the valve
    to provide additional support which acts as a frame
    for the valve and has a similar role to a door frame in
    supporting a door. 

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