Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Physical Examination
LEARNING OBJECTIVES
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Define anatomic components of the mitral valve apparatus
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Describe the etiology of two main types of mitral valve pathology, i.e., mitral stenosis and mitral regurgitation; their mechanistic effects on mitral valve leaflets and physical examination findings.
THE MITRAL VALVE
Anatomy
Mitral valve apparatus components include: two main leaflets, anterior and posterior, each with three distinct scallops (A1, A2, A3, and P1, P2, P3), mitral annulus, chordae tendinae (primary, attached to valve free edge, and secondary, attached to ventricular leaflet surface), and papillary muscles connecting mitral valve leaflets to left ventricle ( Fig. 4.1 ). There are two papillary muscles, and each provides chordae tendinae to both mitral valve leaflets. Anterolateral papillary muscle usually has one body but receives dual coronary artery blood supply from left anterior descending and diagonal or obtuse marginal branch of left circumflex artery. The posteromedial papillary muscle has two bodies, receives blood supply from either left circumflex or right coronary artery (dependent upon which is dominant) and is more prone to injury from myocardial infarction due to single coronary artery blood supply.
Physical Examination
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