Mitral valve disease

O.E. Brodde, H.R. Zerkowski, N. Doetsch, S. Motomura, M. Khamssi, M.C. Michel, Myocardial -adrenoceptor changes in heart failure Concomitant reduction in /t1- and 2-adrenoceptor function related to the degree of heart failure in patients with mitral valve disease, J. Am. Coll. Cardiol. 14 (1989) 323-331. 

Rheumatic mitral valve disease is associated with thromboembolic complications at reported rates of 1.5 to 4.7% per year the incidence in patients with mitral stenosis is approximately 1.5 to 2 times that in patients with mitral regurgitation. The presence of atrial fibrillation is the single most important risk factor for thromboembolism in valvular disease, increasing the incidence of thromboembolism in both mitral stenosis and regurgitation four- to sevenfold. In current practice, patients with nonrheumatic atrial fibrillation at low risk for thromboembolism based on clinical characteristics frequently are treated with aspirin. Warfarin therapy is considered in higher-risk patients, especially those with previous thromboembolism and in whom anticoagulation is not contraindicated due to preexisting conditions. 

Hendrikx M, Van Dorpe J, Flameng W, Daenen W. Aortic and mitral valve disease induced by ergotamine therapy for migraine a case report and review of the literature. J Heart Valve Dis 1996 5 235-237. 

Patients most often have more than one medical problem at a time. For people suffering from mitral valve disease along with hypertension, ACE inhibitors seem to be a good choice, but they re not for anyone who has valvular disease and normal blood pressure. 

It produced a small reduction in hospitalizations due to heart failure (nine per 1000 patients-years) balanced by a significant increase in deaths from presumed dysrhythmias. Digitalis is therefore indicated for a small number of patients who have severe heart failure associated with sinus rhythm after treatment with diuretics, vasodilators, beta-blockers, and spironolactone. It remains the drug of first choice in patients with heart failure accompanied by fast atrial fibrillation, especially if due to myocardial or mitral valve disease. A trial of withdrawal of digitalis therapy can be considered in some cases (as noted in point 3 above). 

FIGURE 17-6. Algorithm for the treatment of atrial fibrillation and atrial flutter. Sx = symptoms AVN = AV node DCC = direct-current cardioversion CCB = calcium channel antagonist (verapamil or diltiazem) BB = jS-blocker ASA = aspirin OHD = organic heart disease AADs = antiarrhythmic drugs INR = international normalized ratio MVD = mitral valve disease CHF = congestive heart failure HTN = hypertension DM = diabetes mellitus. 

There is a small risk for bacterial endocarditis in HCM patients with LV outflow obstruction under resting conditions and in those with intrinsic mitral valve disease. Patients undergoing dental or selected surgical procedures that cause blood-borne bacteremia should receive appropriate antibiotic therapy. The administration of nitroglycerin and digoxin generally is discouraged in the presence of a LV outflow obstruction. ... 

Boldt A, Wetzel U, Lauschke J, et al. Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease. Heart 2004 90 400—5. 

Treatment strategies for progressive pulmonary venous hypertension should focus on treatment of the underlying disease. For patients with advanced decompensated systolic heart failure and secondary pulmonary hypertension, it is essential to reduce the pulmonary vascular resistance prior to heart transplantation to prevent acute RV failure of the donor heart. The use of continuous milrinone, occasionally nesirit-ide, and earlier intervention with mechanical circulatory device support (19) as a bridge to cardiac transplantation is considered a standard approach for this group of patients. Earlier intervention with valve repair or replacement for patients with mitral valve disease and aortic valve disease with associated pulmonary hypertension is recommended. 

Atrial fibrillation with mitral valve disease has long been considered a stroke risk factor. Recurrent embolism occurs in 30-65% of patients with rheumatic mitral valve disease who have a history of a previous embolic event. Most of these recurrences (around 60%) develop within the first year. Mechanical prosthetic valves are a prime site for thrombus formation and patients with these valves require anticoagulation [7, 38]. Bacterial endocarditis can cause stroke as well as intracerebral mycotic aneurysms. Because mycotic aneurysms are inflammatory defects in the vessel wall, treatment with systemic thrombolysis or anticoagulation can lead to rupture with subsequent lobar hemorrhage. Nonbacterial, or marantic, endocarditis is also associated with multiple embolic strokes. This condition is most common in patients with mucinous carcinoma and may be associated with a low-grade disseminated intravascular coagulation. A nonbacterial endocarditis, called Libman-Sacks endocarditis, occurs in patients with systemic lupus erythematosus (SLE) [42],... 

Only a few reports exist that deal with the accuracy of MDCT for detecting and quantifying mitral valve disease, i.e., mitral valve regurgitation and/or stenosis (Alkadhi et al. 2006 Messika-Zeitoun et al. 2006) (Fig. 19.6). Very little information is available on the usefulness of MDCT for the diagnosis of pulmonary valve and tricuspid valve disease. Thus, the value of MDCT in diseases of the mitral valve, pulmonary valve, and tricuspid valve is still unclear, and echocar-... 

Left atrial abnormality, also known as P. mitrale, as it is commonly associated with mitral valve disease (Fig. 5.6). Left atrial abnormality is seen on an ECG as broad, notched/bifld M shaped P waves. These P waves are often greater than 2.5 mm in width (see Fig. 5.7). This is best seen in leads II and Vi. Another indicator is seen in lead Vi where there is a negative deflection below the base line of more than 1 mm and a width greater than 1 m (Fig. 5.8). 

Valvular heart disease (especially mitral valve disease). 

Heart failure, tricuspid or mitral valve disease, pulmonary embolism, cor pulmonale, Inferior-wall Ml, and pericarditis. 

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