00:01
People always ask me "Dr. Raj, what is
the difference between mitral regurg and mitral
valve prolapse." Well, this topic of valvular heart
disease brings us to issues of the mitral
valve in general. Walk you through mitral stenosis
and then have you differentiate between mitral
regurgitation and mitral valve prolapse. And
for learning purposes, please make sure that
you distinguish and you keep separate mitral
regurg and mitral valve prolapse. Trust me
you will make here life so much more easier
and you will be the MVP of this particular
section. Let us begin. Mitral stenosis is where
we are. And before
we start you need to conceptualize this.
I already have, but it is about me imparting
that conceptualization onto you. Mitral valve
stenosis, what does that mean? Difficulty
with opening. In this case, the mitral valve
doesn't want to open. When is the mitral valve
supposed to open? During what? Diastole good.
During diastole was when the mitral valve
was supposed to open, but it does not. And
so, therefore, what kind of valvular heart
disease would you categorise this as? A diastolic
murmur. So now, we have two diastolic murmurs or
we will have two diastolic murmurs that we
have gone through. The first one being aortic
regurgitation. And with aortic regurgitation,
it was the fact that the aortic valve was
unable to close properly and the diastolic murmur
was early, immediately after S2. In this case,
well there is a little bit different actually
a lot different. And if you were doing an echocardiogram
and the mitral valve doesn't wish to open,
then your focus clinically is on a patient,
exactly like that actually, it wasn't me that have
a frog in my throat, it is the fact that my
left atrium was obstructing my esophagus.
So maybe I have dysphagia and maybe it was
disrupting my left recurrent laryngeal nerve
hence the soreness or should I say more or
less the hoarseness that I was exhibiting earlier.
Why? Because the left atrium has been enlarged.
02:30
Is that clear? Now as you as soon your left
atrium becomes enlarged, then obviously, things
are going to back up into where, please? Pulmonary
veins. So you have issues with the lungs.
02:42
Keep that in mind and as you move forward
the main distinguishing feature between mitral
valve stenosis and mitral valve regurgitation
as we shall see will be the size of the left
ventricle. And those of you that are already
ahead of me know exactly as to what I am referring
to and in mitral stenosis, the left ventricle
is going to be rather small because you cannot
get any blood into it. If that is the case
and we have mitral stenosis, and it doesn't
want to open during diastole. On your left
is the normal picture. On the right, guess
what? I cannot open my mitral valve, why?
Well, we would get to those etiologies here
in a second, but the left atrium becomes rather
large and when it does so you can only imagine
that those structures posterior to the left
atrium are then going to be compromised, including
what? The esophagus, your patient is going
to be complaining of dysphagia. In addition,
there is going to be hoarseness and maybe
there will be issues with breathing because
of pulmonary edema.