The medicos PDF app was used to collect this information. I stumbled discovered this amazing app when searching for various slides and books and decided to share it with you all. The Google Play Store has a free version of the app. Importance for learners: MBBS/Dental Nursing Pharmacy Microbiology BPH MPH MDS MD Ophthalmology Paramedics

1. SLIDE TAKEN FROM MEDICOS PDF APP:
HTTPS://BOOKAPP
.PAGE.LINK/RAJIT

2. • SMALL AMOUNT IS COMMON IN THE POPULATION, BUT CLINICALLY SIGNIFICANT IN 2%.
CAUSES
PRIMARY CAUSES:
• MITRAL VALVE PROLAPSE (CAUSES 50%).
• CALCIFICATION
• RHEUMATIC HEART DISEASE.
• INFECTIVE ENDOCARDITIS.
• CONGENITAL
• PAPILLARY MUSCLE RUPTURE DUE TO MI.
• APPETITE SUPPRESSANTS.
• TRAUMA
SECONDARY CAUSES (AKA 'FUNCTIONAL'):
• LV DILATATION DUE TO IHD.
• DILATED CARDIOMYOPATHY.
• HCM
•

3. • COMMON (5% OF POPULATION) 'MYXOMATOUS' DEGENERATION OF VALVE IN WHICH
THICKENED VALVE LEAFLET IS DISPLACED INTO LEFT ATRIUM DURING SYSTOLE, USUALLY CAUSING
SLIGHT REGURGITATION, AND WITH A MINORITY PROGRESSING TO SIGNIFICANT MITRAL
REGURGITATION.
• CAN BE STANDALONE OR PART OF A CONNECTIVE TISSUE (MARFAN'S, EHLERS DANLOS) OR
HEART DISEASE (ATRIAL SEPTAL DEFECT, PERSISTENT DUCTUS ARTERIOSUS, CARDIOMYOPATHY).
• ASYMPTOMATIC, OR CAUSES PALPITATIONS AND CHEST PAIN. MID-SYSTOLIC CLICK OR LATE
SYSTOLIC MURMUR ON AUSCULTATION.

4. ASYMPTOMATIC OR:
• SOB
• FATIGUE
• CHEST PAIN.
• LVF SYMPTOMS.
• SYMPTOMS OF AF (THOUGH THIS IS COMMONER IN MITRAL STENOSIS): PALPITATIONS AND AN IRREGULARLY
IRREGULAR PULSE.
SIGNS:
• PANSYSTOLIC MURMUR HEARD AT APEX, RADIATES TO AXILLA.
• HYPERDYNAMIC APEX BEAT.
• SYSTOLIC THRILL OVER APEX.
• SOFT S1.
• LVF SIGNS: S3, CRACKLES.
ACUTE MITRAL REGURGITATION – E.G. DUE TO INFECTIVE ENDOCARDITIS OR PAPILLARY MUSCLE RUPTURE –
CAN PRESENT WITH PULMONARY OEDEMA.

5. • MITRAL REGURGITATION.
• TRICUSPID REGURGITATION: LOUDER ON INSPIRATION.
• VSD: USUALLY YOUNGER PATIENT AND APEX NON-DISPLACED.

6. ECHO IS DIAGNOSTIC.
ECG:
• AF
• P-MITRALE IF IN SINUS RHYTHM: BIFID/BROAD P-WAVE DUE TO LARGE LEFT ATRIUM.
• LVH
CXR:
• ENLARGED LEFT VENTRICLE AND ATRIUM: DOUBLE RIGHT HEART BORDER.
• VALVE CALCIFICATION.
FURTHER TESTS:
• CARDIAC MRI, ANGIOGRAPHY, AND CATHETERISATION, IF INDICATED.
• BNP MAY PROVIDE PROGNOSTIC INFORMATION.

7. MEDICAL:
• MANAGE AF AND HF IF PRESENT.
• MANAGE ACUTE MR AS ACUTE HEART FAILURE, WITH THE ADDITION OF SODIUM
NITROPRUSSIDE TO REDUCE AFTERLOAD, AND INTRA-AORTIC BALLOON PUMP IF HYPOTENSIVE.
• 6-MONTHLY FOLLOW UP AND ANNUAL ECHO IF SEVERE.
SURGICAL:
• INDICATIONS: SYMPTOMATIC MR, ACUTE SEVERE MR (EMERGENCY), OR MR COMPLICATIONS
SUCH AS LVF, NEW-ONSET AF, OR PULMONARY HTN. IN MR SECONDARY TO ISCHAEMIC HF,
SURGERY SHOULD ONLY BE DONE ALONGSIDE PLANNED CABG.
• PROCEDURE: OPEN REPAIR IS 1ST CHOICE. VALVE REPLACEMENT OR PERCUTANEOUS REPAIR ARE
OTHER OPTIONS.
• ANTICOAGULATION: 3 MONTHS AFTER VALVE REPAIR OR BIOPROSTHETIC REPLACEMENT,
LIFELONG AFTER METALLIC REPLACEMENT.

8. COMPLICATIONS:
• STRUCTURAL CHANGES: LEFT VENTRICULAR AND ATRIAL ENLARGEMENT, CHF.
• PULMONARY HTN.
• AF
• INFECTIVE ENDOCARDITIS.
PROGNOSIS:
• 5 YEAR MORTALITY IN SEVERE ASYMPTOMATIC MR: 20%.

9. •