Mitral Regurgitation

Posterior leaflet

What is 1

Posteromedial commissures

What is 2

Anterior leaflet

What is 3

Anterior annulus

What is 4

Anterolateral commissure

What is 5

Posterior annulus

What is 6

Anterolateral pap muscle

What is 7

Posteromedial pap muscle

What is 8

Chordae tendineae

What is 9

A2

What section of the MV is 1

P2

What section of the MV is 2

P1

What section of the MV is 1

A2

What section of the MV is 2

A3

What section of the MV is 3

P1

What section of the MV is 1

A2

What section of the MV is 2

P3

What section of the MV is 3

PLAX

What view is represented by the line

A4C

What view is represented by the line

A2C

What view is represented by the line

Backward flow of blood from LV to the LA during systole

Define MR

During systole through both isovolumic periods

When does MR occur

True

T/F: you will see MR throughout IVRT and IVCT

Big LA

What is the first remodeling change that will occur with MR

Eccentric

What type of hypertrophy will result from chronic MR

Increase in LA vol leads to LAE which will accommodate the extra volume at a lower pressure

Describe the changes that happen with chronic compensated MR

Remains increased until many years later when it fails and decreases

What is the LV EF like with chronic compensated MR

Starling's Law

What law predicts that that LV EF will increases from an increase LA vol

Prolonged LVVO damages the muscle fibres in the LV when it fails and EF drops

Describe what chrnoic decompensated MR is

Decreased

In chronic decompensated MR is SV decreased or increased

Increases

In chronic decompensated MR is LVEDP and LAP decreased or increases

Eccentric

What type of hypertrophy do we expect with chronic decompensated MR

False

T/F: EF is still a good marker of systolic function with chronic decompensated MR

Because 30-50% of the SV us going back into the LA

Why is EF not a good marker of systolic function for decompensated MR

Dp/Dt method

What method should we use instead to measure the systolic function with decompensated MR

Acute MI trauma

What are the two main causes of acute MR

Myocardial infarction

What does MI stand for

Torn leaflet, chordae or pap muscle

What are some examples of trauma to the MV apparatus

LVVO

What does accute MR cause

No time to dilate so pressure increases (LAP) which backs up into the pulmonary and then further results in CHF

Describe how acute MR affects the LA

Forward SV decreases (but total SV increases) which results in tachycardia. As well, afterload decreases which increases the EF

Explain how acute MR affects the LV

Tachycardia

What can the changes to the LV from acute MR result in

Dyspnea, CHF symptoms, palpitations

What are the main three signs of MR

Fatigue and low exercise tolerance

What are some other signs of MR

Cardiomegaly and pulmonary venous congestion

What are 2 signs from a chest X-ray that may indicate MR

LVH, a-fib, murmur

What are some other signs of MR

Soft blowing at apex

What murmur is associated with MR

A-fib

What arrhythmia is associated with MR

A-fib

What rhythm is this

Assess MV in 2D, determine etiology, assess LA/LV size and systolic function, estimate RVSP, estimate severity of the regurge

What are the 5 main steps in assessing MR

Thickening, movement, valve lesions

What are we looking for when assess the MV in 2D

Myxomatous or rheumatic

What may cause thickening of the MV leaflets

Bowing, prolapse, tenting/doming

What are some abnormal MV movements that can be associated with MR

MAC, endocarditis, thrombus, masses

What are some examples of valve lesions in the MV

Organic

What is another term for primary valve disease

Issues related to MV apparatus, either congenital or acquired

What is organic causes of MR

Functional

What is another term for secondary valve disease

Anything causing annular dilatation

What is functional causes of MR

Cardiomyopathies, CAD/decreases systolic function

What are some examples of functional/secondary MR causes

Prosthetic valves

What is another possible cause of MR

Perfectly aligned

Leaflets of the MV need to be ___________ ________ in order to stop any regurgitation

Malformed, torn, or degenerated

What leaflets abnormalities result in poor coaptation

>100mmHg PG

What is the PG between the LV and LA

Elongated, maldeveloped, or ruptured

What are some chordae tendinae abnormalities that can cause MR

Over 120

How many chordae tendinae's does the MV have

True

T/F: inflammation (rheumatic), calcification and endocarditis may affect the charade tendinae in addition to the valve

Calcific chordae tendinae

What is represented by this image

MVP, cleft MV, chordal rupture, flail MV, MAC, LV dilatation, Masses

List 7 examples of MR etiology

Mitral valve prolapse

What does MVP stand for

Systolic bowing of the bellow of the MV leaflets in systole into the LA

What is mitral valve prolapse

>2mm

How far into the LA does the belly of the MV have to go into the LA to be considered MVP

The motion of a prolapsed MV bowing into LA

What does this image represent

Systole (while closing)

What does MVP occur

Because the leaflet edges no longer coapt

Why does MVP lead to MR

No, if one or both leaflets prolapse it is considered MVP

Does both MV leaflets have to bow back to be considered MVP

PMVL bowing back into the LA from MVP

What is represented by this image

PMVL bowing back into the LA from MVO

What is represented by this image

Myxomatous

MVP is a type of ___________________ valve disease (thickening)

Mid-systolic click

What murmur may indicate a MVP

Females

Is MVP more common in males or females

3:1

What is the ratio of F:M for MVP

Myxomatous MV with bowing of AMVL

What is represented by this image

Connective tissue disorders

MVP has a genetic association with:

Marian or Ehler-Danilo's Syndrome

What are two examples of connective tissue disorder that may be associated with MVP

Chordal rupture, bacterial endocarditis, arrhythmias, MVP

What are patients with connective tissues disorders prone to

2-5%

What percentage of the general population has a connective tissue disorder

Tall, slender build sometimes with pet us excavatum

Describe the general appearance of someone with a connective tissue disorder

Congenital deformation of the chest wall that causes several ribs and sternum to grow inwardly

What is pectus excavatum

Marfan Syndrome

What is pectus excavatum syndrome associated with

Pectus excavatum

What is demonstrated by this image

True

T/F: patients that have pectus excavatum are very difficult scans for echo

PLAX zoom

What view do we always measure the bowing of the MVP to determine if it is a true MVP

A4C give false +

Why do we not measure the bowing of a MVP in A4C

Posterior displacement of the prolapsing leaflet(s) in systole (near end of T wave of ECG)

Describe the findings of this image

Opposite direction

How will the MR jet be angled if only one MV leaflet is prolapsed

MR jet angled in the opposite direction of the single prolapsed leaflet

What is this image demonstrating

Slit-like defect in one of the MV leaflets

What is a cleft MV

Rare

Is a cleft mitral valve rare or common

AMVL

What leaflets does the cleft usually occur on

Thickened

If a patient has a cleft MV, the MV may also be ___________