A patient experiences a sudden rupture of the chordae tendineae that results in

Question

A patient experiences a sudden rupture of the chordae tendineae that results in the mitral valve not closing properly. In this patient: (a) Describe the filling of the left ventricle during diastole. (0.5 mark) (b) Describe the movement of the left ventricular blood during systole. (1 mark) (c) Describe what may happen to blood pressure in the pulmonary vein and why. (2 marks) (d) Describe what might be happening in the lungs and the symptoms that may result. (2 marks) (e) Describe what might be happening to cardiac output and arterial blood pressure both in the short-term and in the long-term. (4.5 marks)

Explanation / Answer

A) Mitral valve is a valve present between Left auricle and Left ventricle. This valve brings about one-way flow of blood from auricle to ventricle.During ventricular diastole, ventricular filling takes place and valves are open during this phase. Rupture of chordae tendinae has no significant effect on opening of valves . Hence , filling is not affected.

B) Normally, when ventricles contract, emptying of Left ventricle takes place . Blood from Left ventricle enters Aorta .This phase is known as 'Ventricular Systole' and Mitral valves are closed during this phase.

If there is rupture of Mitral valve, blood goes backward into Left Auricle.This causes overfilling of Left auricle and also raises the pressure of blood .This condition is Mitral Prolapse . This condition can be mild, moderate or severe.

C) As pressure in Left Auricle increases, pulmonary veins ( these veins carry oxygenated blood from Lungs to Left Auricle.) also experience increase in blood pressure as backflow of blood occurs. If mitral prolapse condition is left untreated, this pressure will increase further resulting in major effects.

D)- As seen above , pressure in pulmonary veins increases due to Mitral prolapse. This condition if left untreated, results in Pulmonary Edema.

- Edema means swelling. It occurs when blood from inside blood vessels seeps outside the vessel into the Alveoli of Lungs. This causes problems in exchange of gases and results compromised oxygenation of blood in body.This is the major complication seen.

- Symptoms are

a) Most common symptom is shortness of breath/ breathlessness. It may be gradual or sudden depending on severity of the condition.

b) Fatique

c) Rapid breathing (tachypnea).

d) Dizziness .

e) Low oxygen level in blood (Hypoxia)

- On examination by stethoscope, doctor may hear abnormal lung sounds like rales or crackles (discontinuous short bubbling sound corresponding to splashing of fluid in alveoli).

E) - As we saw, Left ventricle is not able to pump enough blood into the aorta. So there is decrease in Cardiac Output.

- To meet body's demands , Left ventricle has to work harder.The heart muscles and circulatory system undergoes series of changes to overcome this increased demand.

- Major change is Enlargement of Left Ventricle. This is Compensatry Phase which does not cause any symptoms. The heart rhythm is normal and no surgical treatment is required. This is short-term effect seen.

- As the condition progresses, heart muscles begin to weaken and ventricles can no longer compensate for this .This is a dangerous state and results in extreme fatique feeling with decreased ability to exercise or be active .Surgical treatment is needed. This is Transitional Phase.

- As left ventricle enlarges and functions less efficiently , Left auricle begins to enlarge .This results in abnormal rhythms. This increases blood pressure in pulmonary artery resulting in Pulmonary Hypertension. Over time these changes become irreversible and thus signs and symptoms of Heart Failure develop. This is Decompensated Phase.

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