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
