1. THE MERCK MANUAL, Sec. 16, Ch. 207, Valvular Heart Disease General. mitral valve disease. Aortic Valve Disease. Tricuspid Valve Disease.click here for navigation help. mitral valve disease. MITRAL VALVE PROLAPSE. http://www.merck.com/pubs/mmanual/section16/chapter207/207b.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 207. Valvular Heart Disease Topics [General] Mitral Valve Disease Aortic Valve Disease Tricuspid Valve Disease Mitral Valve Disease MITRAL VALVE PROLAPSE A bulging of one or both mitral valve leaflets into the left atrium during systole, commonly producing a crisp systolic sound or click and a delayed or late systolic mitral regurgitation murmur. Primary mitral valve prolapse (MVP) is associated with dilation of the mitral annulus, abnormal chordal insertions, and myxomatous degeneration of the mitral valve, resulting in redundant mitral leaflet tissue and elongated chordae. Complete myxomatous degeneration of the valve can lead to severe mitral regurgitation (MR), or floppy valve syndrome. The tricuspid or aortic valve can also show myxomatous changes and produce tricuspid or aortic valve prolapse. MVP is occasionally familial with autosomal dominant inheritance. Prevalence varies between 1 and 6% in otherwise normal populations. It is higher in persons with Graves' disease, hypomastia, Duchenne muscular dystrophy, myotonic dystrophy, sickle cell disease, atrial septal defect, Marfan's syndrome, and rheumatic heart disease. About 25% of patients have joint laxity, a high-arched palate, or other skeletal abnormalities (eg, scoliosis, funnel chest, straight back). Carnitine and Mg deficiencies have been suggested as etiologic factors; subnormal mean lymphocyte and RBC Mg levels have been reported in patients with MVP.

2. Mitral Valve Disease Text mitral valve disease. View TSDA Curriculum Online for this topic http://www.ctsnet.org/doc/4470

Mitral Valve Disease View TSDA Curriculum Online for this topic 1. Surgical Anatomy of the Mitral Valve Leaflet Anterior leaflet inserts on about 1.3 of the annulus Posterior leaflet inserts into about 2/3 of the annulus Posterior leaflet area is significantly larger than anterior leaflet area The combined leaflet area is twice the mitral orifice Chordae Primary attachment to free margin Papillary Muscles Anterolateral and posteromedial supplying both leaflets 2. Mitral Stenosis Etiology Rheumatic History Dyspnea, fatigue, palpitations, hemoptysis Physical exam Loud 1st heart sound, diastolic, rumble, opening snap Chest X-Ray Left atrial and right ventricular enlargement 3. Cardiac Catheterization Mitral valve area = diastolic flow ÷ %pressure gradient (Gorlin formula) Normal Mitral valve area 4.0-5.0 cm Symptomatic mitral stenosis 1.4-2.5 cm Critical mitral stenosis <1.0 cm [link to video clips for Congenital Stenosis, Rheumatic x 3 and Ruptured Chordae] 4. Natural History Mitral Stenosis Continuous progressive, life-long disease Slow, stable early course, latent period of 20-40 years from Rheumatic fever to onset of sypmtoms

3. THE MERCK MANUAL, Sec. 16, Ch. 207, Valvular Heart Disease Description of tricuspid regurgitation and stenosis. Symptoms, signs, diagnosis and treatment are Category Health Conditions and Diseases Tricuspid Valve Disease...... Topics. General. mitral valve disease. Aortic Valve Disease. TricuspidValve Disease. click here for navigation help. Tricuspid Valve Disease. http://www.merck.com/pubs/mmanual/section16/chapter207/207d.htm

This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 16. Cardiovascular Disorders Chapter 207. Valvular Heart Disease Topics [General] Mitral Valve Disease Aortic Valve Disease Tricuspid Valve Disease Tricuspid Valve Disease TRICUSPID REGURGITATION (Tricuspid Incompetence or Insufficiency) Retrograde flow of blood from right ventricle to right atrium due to inadequate apposition of the tricuspid valves. Symptoms, Signs, and Diagnosis In addition to low output symptoms (eg, fatigue, cold skin, dyspnea, edema), the only specific symptom of severe TR is the sensation of pulsations in the neck due to the high jugular regurgitant (CV) waves from the transmitted RV pressure. Right upper quadrant abdominal discomfort due to hepatic congestion may occur. Atrial fibrillation or flutter, which usually occurs when the right atrium enlarges, further decreases the CO and may precipitate sudden, severe heart failure. The jugulars may have various degrees of v wave and y descent, depending on the degree of TR, which is associated with various degrees of systolic pulsation of the liver synchronous with the v waves. With gross TR, there is often a systolic murmur and thrill over the right jugular. A pansystolic TR murmur may be high-pitched if trivial and secondary to pulmonary hypertension, or of medium frequency if rather gross and primary. It often increases on inspiration (Carvallo's sign). Usually, it is best heard at the 4th and 5th intercostal spaces close to the sternum or in the epigastrium, but it is loudest at the apex if the RV usurps that area and over the free edge of the liver if secondary to cor pulmonale from emphysema.

4. Mitral Valve Disease mitral valve disease (Mitral Valve Regurgitation) by Jennie Bullock There aremany diseases which affect the mitral valve and its supporting structures. http://www.barkbytes.com/medical/med0045.htm

Mitral Valve Disease (Mitral Valve Regurgitation) by Jennie Bullock There are many diseases which affect the mitral valve and its supporting structures. The most common disorder of the mitral valve is the partial backflow (regurgitation) of blood through the valve. Regurgitation is usually the result of valvular degeneration, which occurs most often in older members of the smaller dog breeds. In valvular degeneration, the leaflets or cusps which make up the valve, may have contracted and curled back on themselves. This allows the valve to leak. Valvular degeneration can also be a secondary result of an infection of the valve (endocarditis), or as a congenital (present at birth) malformation of the valve. With mitral regurgitation the blood backflows (leaks) from the left ventricle into the left atrium of the heart. This regurgitation frequently occurs which such velocity that it produces a turbulence. This turbulence can usually be detected as a systolic murmur, heard between the first and second heart sounds. As a result of mitral regurgitation the excess blood accumulates in the left atrium causing it to enlarge. The enlargement of the left atrium can lead to enlargement of the left ventricle. The amount of regurgitation is directly correlated with the size of the left atrium and ventricle.

5. Cavalier King Charles Spaniel Club Of Canada Health Article mitral valve disease Currently the most serious problem facing Cavlier breeders today is mitral valve disease. It is estimated that this may affect as much as 50% of the dogs in the breed in North America at this point. http://www.io.com/~bcrider/cavalier/health_mvd.html

Mitral Valve Disease Currently the most serious problem facing Cavlier breeders today is Mitral Valve Disease. It is estimated that this may affect as much as 50% of the dogs in the breed in North America at this point. MVD leads in many cases to premature death or compromised quality of live and occurs in Cavaliers at a rate unknown in any other breed in the world. Dr. Mike O'Grady, cardiologist affiliated with the Ontario Veterinary College, University of Guelph, Ontario, Canada has been collecting data since 1993. You should quiz the breeder about the steps they are taking to avoid MVD in their lines. Remember that this is a relatively new problem to be recognized in the breed and no firm or consistent policies have been set as data is still being collected. It appears that color doppler ultrasound exams are the best for picking up evidence of MVD, but auscultation exams are also often done. In addition, the evidence appears to be mouinting that puppies bred from parents who show clear of MVD at older ages (3-5 years) are more likely to be clear themselves or to develop the less virulent form of MVD. Request to SEE the documentation for the dam. You should also be able to see copies for the stud dog even if it doesn't live with the breeder.

6. Cavalier King Charles Spaniels - Mitral Valve Disease mitral valve disease in Cavalier King Charles Spaniels. There is currently noway of detecting early in life tendency to develop mitral valve disease. http://home.vicnet.net.au/~cavalier/mitral.htm

Breed Information Breed Description Breed History Breed Standard Cavalier's Bookshelf ... Mitral Valve Disease Club Information Breeder Profiles Club Activities Club History Contacting Us ... Rescue Story Links Canine Associations Cavalier Clubs Home Cavalier King Charles Spaniel Club Of Victoria Inc. Mitral Valve Disease in Cavalier King Charles Spaniels The following article has been provided by Dr Russell Mitten, BVSc DVR (Consultant), who addressed the Club's General Meeting on the 15th February 2000. What is it? What goes wrong? Over a period of time we see progressive deterioration of the heart valves. The most commonly affected is the mitral valve, on the left side, followed by the tricuspid valve (on the right)and the aortic valve (on the left). The normal flexible thin valve leaflets become gnarled, fibrous and thickened, and their restraining tendons also thicken and sometimes rupture. The result is an incompetent leaky valve which allows progressively more and more backflow. Eventually up tp 80% of the output from the heart is leaking back through the valve (termed regurgitation) and only 20% is moving forward. As a result, the heart chambers enlarge, the heart muscle works harder and eventually the muscle may fail. In some cases, the thin-walled atrial chambers may rupture, and in others the valve tendons give way, both having disastrous (ie fatal) consequences. What are the signs?

7. Mitral Valve And Mitral Valve Prolapse mitral valve disease in cavalier king charles spaniels see later, there is now strong evidence of a genetic basis for mitral valve disease in both Cavalier and Dachshunds. http://www.americanheart.org/presenter.jhtml?identifier=4717

8. Barnaby's Cavalier Attitudes: Rufus' Have A Heart Page King Charles Spaniel by Malcolm Dupre, and on. mitral valve disease (Mitral Valve Regurgitation) by Jennie Bullock http://www.cavalierkingcharles.com/Rufus

"The price of wisdom is above rubies" Job 28:18 Rufus 20th April 1986 - 5th May 1998 This page tells the story in words and pictures of Rufus, a Ruby Cavalier who suffered from MVD. It includes links to sites that have information on MVD (mitral heart disease) and has a comprehensive bibliography on this subject. After a long and often very distressing battle against heart disease, this valiant little Cavalier has finally passed away. Although he was a timid and nervous dog, he endured his illness with great dignity and fortitude, thus earning our undying admiration and respect. Hello! My name is Rufus and I am a Ruby Cavalier with a heart problem. I was born in Wales in 1985, and came to my home by way of Barkham in Berkshire. Good name for a puppy's place isn't it? My lady found the Ruby quote for me and said it is just right as I am as thick as THREE short planks . But I am not that stupid, and to prove it I have made this web page so you can find some links to other pages with information about Cavalier heart problems. My name means Red - I know that, and my lady sometimes calls me "Little Red Rufe" - but the children that used to play with me - they thought my name was "Rooftops!" So, who's stupid, then?

9. CTSN--Mitral Valve Disease http://www.ctsnet.org/doc/5965

Back to CTSN Home Page Last revised 07/08/2000 http://www.ctsnet.org/residents/ctsn/ Comments to John Doty Last revised Sep-21-2001 Revised by Stephen H. McKellar

10. Mitral Valve Disease But when the mitral valve disease is present, the valve no longer opensor closes properly. Common mitral valve problems are mitral http://www.wiheart.cardiologydomain.com/images/uploaded/WiscHeart/MVD.cfm

Basic Facts A normal mitral valve opens wide to allow blood from the left atrium to flow into the left ventricle and closes tightly as blood is pumped out of the left ventricle. Mitral stenosis is a narrowing or obstruction of the mitral valve that prevents the valve from opening properly, and mitral regurgitation means that the mitral valve does not close fully, allowing blood to flow backwards into the atrium when the left ventricle contracts. In mitral valve prolapse, the most common form of valvular heart disease in the United States, the flaps of the mitral valve may protrude or billow back into the left atrium. The heart is a muscular pump divided into four chambers. Two thin-walled chambers, the left atrium and right atrium, form the upper part of the heart. The other chambers, the left and right ventricles, are the heart’s main blood-pumping chambers and form the bottom part of the heart. The right atrium receives blood as it returns to the heart from the veins from different parts of the body and transports blood to the right ventricle, and the left atrium receives oxygenated blood from the lungs and transports it to the left ventricle. The right ventricle pumps blood into the lungs to be oxygenated, while the left ventricle pumps blood to the rest of the body to deliver the oxygen. The valves in the heart affect the way that blood flows through the chambers of the heart. There are two valves on the right side of the heart, the tricuspid and pulmonary valves, and two valves on the left side of the heart, the mitral and aortic valves. These valves resemble flaps, and each valve is made up of segments or leaflets. The valves open and close to keep blood flowing through the heart in only one direction.

11. Mitral Valve Dysplasia What is mitral valve disease? The heart consists of 4 chambers 2atria and 2 ventricles. How is mitral valve disease inherited? http://www.upei.ca/~cidd/Diseases/cardiovascular diseases/mitral valve dysplasia

related terms: mitral valve disorder, mitral valve malformation, mitral dysplasia, mitral systolic murmur What is mitral valve disease? The heart consists of 4 chambers - 2 atria and 2 ventricles. The atrioventricular (AV) valves ensure that the blood flows from the atria to the ventricles when the heart beats. A defect in the mitral valve (the left atrioventricular valve) causes backflow of blood into the left atrium, or mitral regurgitation. Less commonly, a narrowing or stenosis of the valve can be identified. Because of the leaky valve, the heart is less efficient at pumping blood to the body. Mitral valve insufficiency is the most common acquired cardiac disease in older dogs, affecting over one third of dogs greater than 10 years of age. In some breeds however, mitral insufficiency develops at a much younger age, due to an inherited predisposition for this disorder. In some breeds, abnormal development (dysplasia) of the valve has been identified in the embryo. How is mitral valve disease inherited? Although the pattern of inheritance has not been identified, it is agreed that there is a genetic basis for the early development of mitral valve disease.

12. Mitral Valve Disease : Symptoms, Risk Factors, Prevention, Diagnosis, Therapy, F Home Conditions mitral valve disease, mitral valve disease. Illustrationmitral valve disease. Image of blood flow into the heart. http://www.sjm.com/conditions/condition.aspx?name=Mitral Valve Disease

13. Mitral Valve Disease : Therapy : St. Jude Medical Home Conditions mitral valve disease Therapy, Therapy. Mitral ValveDisease Valve disease may require surgery. This surgery may http://www.sjm.com/conditions/condition.aspx?name=Mitral Valve Disease§ion=T

14. Pediatric Cardiology: Mitral Valve Disease mitral valve disease. Chest Radiograph Mitral stenosis, child; Mitralstenosis, child, barium swallow Diagrams Mitral Valve Prolapse; http://www.kumc.edu/kumcpeds/cardiology/mitralvalvedfct.html

Mitral Valve Disease Chest Radiograph: Mitral stenosis, child Mitral stenosis, child, barium swallow Diagrams: Mitral Valve Prolapse Auscultation areas Cardiac cycle Echocardiogram (video): Normal heart, aortic arch Normal heart, branch pulmonary arteries Normal heart, long axis, (with labeled frame) Normal heart, long axis #2 ... Parachute mitral valve Echocardiogram (still frame): M-mode, left ventricle, normal M-mode values 4 chamber view, normal (4c) 4 chamber view 1, normal (4c invert) ... Echo diagram, suprasternal notch Electrocardiogram: Mitral regurgitation, adolescent Normal, #1, child Normal, #2, child ECG 12 lead interval diagram ... Return to the defect index page

15. Mitral Valve Disease A Chapter from the Cleveland Clinic's Disease Management Project, authored by BrianGriffin, MD and Emil Hayek, MD, which deals with mitral valve disease. http://www.clevelandclinicmeded.com/diseasemanagement/cardiology/mitralvalve/mit

Published May 29, 2002 Brian Griffin, MD Department of Cardiology Emil Hayek, MD Department of Cardiology Print Chapter The Cleveland Clinic Foundation The mitral valve is made up of the annulus, the anterior and posterior leaflets, and the chordae, which attach the leaflets to their respective papillary muscles. A normally functioning valve allows blood to flow unimpeded from the left atrium to the left ventricle during diastole and prevents regurgitation during systole. Normal mitral valve function is dependent not only on the integrity of the underlying valvular structure, but on that of the adjacent myocardium as well. This chapter reviews three types of mitral valve disease: mitral stenosis, mitral regurgitation (including primary nonischemic, ischemic, and functional mitral regurgitation), and mitral valve prolapse. Practice guidelines published jointly by the American College of Cardiology (ACC) and the American Heart Association (AHA) for the management of patients with valvular heart disease are referenced within this chapter.

16. Heart Valve Disease mitral valve disease. The mitral valve is located between the leftsidedfilling chamber (atrium) and the pumping chamber (ventricle). http://www.med.umich.edu/hcp/pa_info/vle_dse.htm

P ATIENT I NFORMATION ... ROGRAM Heart Valve Disease The filling and pumping chambers on each side of the heart are separated by one-way valves. These four valves each have two or three tissue flaps called leaflets that act as doors which open and close to ensure that blood flows only in the proper direction. Left side valves: mitral valve: between the left atrium (filling chamber) and the left ventricle (pumping chamber) aortic valve: between the left ventricle and the aorta (a large artery that takes blood to the rest of the body) Right side valves: tricuspid valve: between the right atrium (filling chamber) and the right ventricle (pumping chamber) pulmonic valve: between the right ventricle and vessels leading to the lungs Valve problems present from birth are called congenital malformations. Other valve deformities are not acquired until later in life. Conditions such as an infection can invade or damage the vaIve leaflets or doors. The natural aging process may weaken already damaged valve leaflets or harden normal valve tissue. Valve problems produce many symptoms. Faulty heart valves can cause dizziness, shortness of breath, fatigue, irregular heart beats, fluid buildup, strokes and heart attacks. Tests such as an echocardiogram or a cardiac catheterization can show if heart valves are damaged or not functioning properly.

17. U-M CVC - Mitral Valve The UM Medical Center is a leader in the diagnosis and treatment of mitralvalve disease. For more information on mitral valve disease click here. http://www.med.umich.edu/cvc/adult/sermit.htm

Mitral Valve Clinic Taubman Health Care Center 1500 E. Medical Center Drive Floor 2, Reception Area B Floor 3, Reception Area C Ann Arbor, MI 48109-0344 Phone 734-936-1900 Directors: Steven F. Bolling, MD and Mark Starling, MD The U-M Medical Center is a leader in the diagnosis and treatment of mitral valve disease. The Mitral Valve Clinic offers coordinated and comprehensive evaluation, treatment and follow-up for patients with identified or suspected mitral valve disease. For more information on mitral valve disease click here. UM Cardiovascular Center 300 North Ingalls Building Ann Arbor, MI 48109-0477 http://www.med.umich.edu/ UMHS Home CVC Home Contact Us About MCHC

18. Mitral Valve Disease mitral valve disease. The heart is a muscular pump divided into fourchambers. Two thinwalled chambers, the left atrium and right http://www.tcg.cardiologydomain.com/images/uploaded/TCG/Mitrial.cfm

Mitral Valve Disease The heart is a muscular pump divided into four chambers. Two thin-walled chambers, the left atrium and right atrium, form the upper part of the heart. The other chambers, the left and right ventricles, are the heart’s main blood-pumping chambers and form the bottom part of the heart. The right atrium receives blood as it returns to the heart from the veins from different parts of the body and transports blood to the right ventricle, and the left atrium receives oxygenated blood from the lungs and transports it to the left ventricle. The right ventricle pumps blood into the lungs to be oxygenated, while the left ventricle pumps blood to the rest of the body to deliver the oxygen. The valves in the heart affect the way that blood flows through the chambers of the heart. There are two valves on the right side of the heart, the tricuspid and pulmonary valves, and two valves on the left side of the heart, the mitral and aortic valves. These valves resemble flaps, and each valve is made up of segments or leaflets. The valves open and close to keep blood flowing through the heart in only one direction. The tricuspid valve separates the right atrium and right ventricle. When the heart beats, the tricuspid valve is pushed shut, preventing blood from flowing backward from the right ventricle into the right atrium. When the heart relaxes, the tricuspid valve opens, allowing blood from the right atrium to fill the right ventricle. When the heart beats, the pulmonary valve is pushed open, allowing blood to flow into the lung arteries. When the heart relaxes, the pulmonary valve closes, preventing blood from flowing backward into the right ventricle.

19. UPDATE ON CANINE MYXOMATOUS MITRAL VALVE DISEASE AND HOW IT IS DIAGNOSED UPDATE ON CANINE MYXOMATOUS mitral valve disease AND HOW IT IS DIAGNOSED H D. Pedersenthe Royal Veterinary and Agricultural University, Denmark Waltham Focus http://www.inno-vet.com/journals/walfocus/10/0101.html

UPDATE ON CANINE MYXOMATOUS MITRAL VALVE DISEASE AND HOW IT IS DIAGNOSED H D. Pedersen the Royal Veterinary and Agricultural University, Denmark Waltham Focus Vol 10, No.1 KEY POINTS INTRODUCTION Myxomatous valvular disease, also known as mitral valve disease, chronic valvular disease or endocardiosis, is a common disease in the dog which especially affects the mitral valve (1). The prevalence and severity of the disease increases with increasing age. At post-mortem, more than half the population of old dogs have markedly distorted mitral valves. As a consequence of the progressive valvular degeneration, the valve becomes increasingly insufficient and in some cases, the degree of mitral regurgitation (MR) gets so severe that the dog develops congestive heart failure. Recent studies have shown that the disease can be diagnosed echocardiographically at an early stage, for example by measuring the degree of mitral valve prolapse (MVP), i.e. the degree of abnormal leaflet protrusion towards the left atrium in systole. This early detection, and the heritable nature of the disease, make it feasible to design control schemes aimed at reducing the prevalence of the disease in predisposed breeds. Note that using cardiac auscultation alone it is not possible to diagnose early stages of mitral valve disease, where there is no MR. Even in cases with mild MR, there is often no perceivable murmur. As the degree of MR worsens, however, so does the murmur intensity and thus the likelihood of diagnosing the disease by auscultation increases.

20. PROFESSIONAL REFERENCE Allergy Immunlogy Cardiology Dermatology mitral valve disease by Sidney C Smith, MD and Park W Willis IV, MD, BestPractice of Medicine. February 2001. Last modified October 25, 2001. http://merck.praxis.md/index.asp?page=bpm_brief&chapter=BPM01CA16

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