Question

Mr. J , now 64 years old, was diagnosed with mitral valve prolapse and regurgitation in his early 50’s while undergoing work-up for chest pain. He takes Lisinopril and Hydrochlorothiazide to control hypertension. Today he comes for his yearly cardiology physical assessment and echocardiogram.

1. What should the provider ask Mr. J in order to determine if he is having symptoms of worsening mitral regurgitation?

2. Explain the pathophysiologic significance of each of these symptoms.

3. What are the expected findings on a physical examination given his diagnosis and which findings on the examination would indicate worsening of mitral regurgitation?

4. What specific characteristics of the chambers of the heart and flow of blood through the heart will the provider look for in the echocardiogram?

Answer 1

1.SYMPTOMS OF HEART FAILURE RELATED TO MITRAL VALVE REGURGITATION

1. Shortness of breath ,especially with exertion or when lying position
2. Swelling in the legs
3. Fatigue ,exhaustion,weakness
4. Fainting

2.PATHOPHYSIOLOGY OF SYMPTOMS

• Shortness of breath: When valve regurgitation is present one or more valves of heart do not close properly during each cardiac cycle.This leads to leakage of blood to chamber.Dyspnea may occur when heart must work more harder to supply the oxygenated blood to the body
• Swelling of legs: Edema results from backup from the mitral valve to lungs to the right side of heart to the venous system and finally to the legs and ankles.
• Fatigue: The blood coming through the left side of heart fuels the entire body with oxygented blood from lungs . If some of that blood is flowing back into the heart itself due to the condition.The person will feel tired and lightheaded specifically if active.
• Fainting or syncope:If the heart slows down enough to reduce the flow of blood to brain , dizziness or fainting may occur.

3.Physical examination : Crucial findinds will be found in all steps of examination like inspection,palpation and maily auscultation.To suspect this condition doctor may here a abnormal movement of mitral valve make disticnt sound called a 'click' and also murmur while ausculting.To diagnose regurgitation echocardiogram is required .The length of the murmur , as opposed to the intensity .The physician should also look for sever cases with symptoms of endocarditis ,congestive heart failure etc.

4. The diagnosis and severity is assesed with the Echo results.

M-mode echo :Thickened ,calcified leaflets,open poorly,close slowly (EF SLOPE REDUCES),the double peak disappear.

TWO DIMENSIONAL ECHO:Fusion,thickening,doming of the valve leaflets and poor leaflet separation in diastole.