Questions on mixed mitral valve disease

MS with MR/Mixed mitral valve disease

  • What is the predominant lesion and why? A
  • What are the findings if MR is predominant? A
  • What are the differentiating features of predominant mitral lesions? hs
  • What investigations should be done? A, hs
  • What is the cause of mixed MS and MR? a, hs
  • In which lesion of MR or MS, endocarditis is common? A
  • How will you treat your case? A, hs

 

 


Rimikri

SOLVES


MS with MR/Mixed mitral valve disease

What is the cause of mixed MS and MR?

Chronic rheumatic heart disease.

* Short and Long Cases in Clinical Medicine, HN Sarker Page: 45
What is the predominant lesion in this patient and why?

Example for MS:

Predominant lesion is MS, because:

  • Pulse: Low volume
  • Apex beat: Not shifted and tapping in nature
  • First heart sound is loud.
* Long Cases in Clinical Medicine, ABM Abdullah Page: 181
What are the findings if MR is predominant?

If MR is predominant:

  • Pulse: Normal/high volume
  • Apex beat: Shifted and thrusting in nature
  • First heart sound is soft or absent
  • There may be third heart sound.
* Long Cases in Clinical Medicine, ABM Abdullah Page: 181
What are the differentiating features of predominant mitral lesions?

Differentiating features of predominant mitral lesions.

Clinical features Predominant mitral stenosis Predominant mitral regurgitation
Pulse Small volume Sharp and jerky
Apex beat Undisplaced and taping Displaced and thrusting
First heart sound Loud (if leaflets are mobile) Soft
Third heart sound Not present Present
* Short and Long Cases in Clinical Medicine, HN Sarker Page: 45
In which lesion of MR or MS, endocarditis is common?

Endocarditis is common in MR.

* Long Cases in Clinical Medicine, ABM Abdullah Page: 182
What investigations should be done?

As follows:

  • X-ray chest PA view
  • ECG
  • Echocardiography, 2D, M-mode and preferably color Doppler
  • Cardiac catheterization
* Long Cases in Clinical Medicine, ABM Abdullah Page: 182; Short and Long Cases in Clinical Medicine, HN Sarker Page: 45
How will you treat your case?

As follows

  • Mild and asymptomatic: Conservative treatment:
    • Rest,
    • Diuretic,
    • Prophylactic penicillin to prevent infective endocarditis,
    • Antiplatelet like aspirin, warfarin to prevent thromboembolism.
  • In severe case:
    • Valve replacement.
* Long Cases in Clinical Medicine, ABM Abdullah Page: 182; Short and Long Cases in Clinical Medicine, HN Sarker Page: 45
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