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Mitral Valve Disease (Mitral Stenosis (Pathophysiology (Chronic LV…

- - - - Tachycardia
        Needs bradycardia for longer LV filling time
        Any reduction in LV filling reduces CO
        When Hr increases across fixed MV orifice the gradient across the valve increases
      - Increases in PAP
      - Fluid overloading
      - Sympathetic stimulation
        
        Tachycardia reduces LV filling
        
        Elevated flow across valve
        Increases pressure gradient across valve
        Increases LA pressure and therefore PAP
    - - After load
        Reducing doesn't change forward flow because SV determined by MV orifice and diastolic filling time
  - - - All AF + MS = anticoagulation
- - - - Bradycardia
        Increases time for regurgitant flow
        Increases LV distension
      - Raised SVR (BP or volume)
        Increases regurgitant volume
      - Reducing CO
        Use inotrope for hypotension
      - Exacerbating HPV
    - - Tachycardia
        Reduces regurgitant time
      - Sinus rhythm
        Maximises atrial contribution to CO
      - Reduce after load
        Enhances forward CO and BP
      - Reduce or maintain normal SVR
        Promotes forward flow