258 - Mitral Stenosis Flashcards
What is the most common cause for mitral stenosis?
Rheumatic fever (40%)
What are the common causes for MS (Mitral stenosis)s (6)?
Rheumatic fever Congenital (parachute valve, cor triatriatum) Severe calcification SLE, RA Myxoma IE with large vegetations
MS caused by rheumatic disease is caused by ____
leading to _____ of the valve leaflets together with ___ and ____ tissue . The end result is hardening of the leaflets and shortening of the ___ causing stenosis
Chronic inflammation Thickening Fibrotic calcified Chordae tendineae
What is the normal valve area?
4-6 cm2
What the the area of valve stenosis and severe stenosis?
> 2 cm2
>1.5 cm2
Pulmonary HTN due to MS will cause ____, secondary ___ and ___ insufficiency and ____
Right ventricle enlargement
Tricuspid
Pulmonary valve
RHF
MS symptoms usually appear on the ___ of life, ___ years after rheumatic injury. Once severe symptoms appear and if not treated life expectancy is __ years
4th
20
2-5
The severity of symptoms is ___ with the ___ of the valve’s ____
In correlation
Severity
Stenosis
What does permanent AF together with MS reflect?
Acceleration of clinical deterioration
What symptoms will appear as the MS progresses?
Light exertion symptoms
Orthopnea
PND
Why hemoptysis may occur with MS?
Increase in pulmonary vein pressure- a non fatal process
There’s an increased risk for ___ in patients with MS, and it is a major ___ and ___ factor
PE
Mortality
Morbidity
_____ will be more prevalence in MS
Lung infections
In MS patients with severe ____ and ___, increased ___ and ___ may be noticed
Pulmonary HTN
Secondary tricuspid regurgitation
JVP
A waves
In MS patients systemic ___ will be ___ or even ___
BP
Normal
Low
In early stages of MS the __ sound will be ___ and ___
1st
More profound
Late
The ___ sound will be ___ in patients with ____
2nd
Split
Pulmonary HTN
During expiration in MS patients ____ may be heard medially to the ____, slightly after the ___ of the aortic valve
Opening snap
Apex
Closure sound
The more the MS becomes more severe, the more time passes between the ____ and the ____
Opening snap of the MS
Closure of the aortic valve
In MS patients with preserved CO, the ____ of the ____ is in direct correlation to the stenosis severity
Length
Murmur
What will you see in the ECG of a MS patient? (2)
- Sharp P wave on lead II
- High P wave in V1
- Right axis
What is the most useful imaging tool for MS diagnosis?
TTE
What are the signs for MS in CXR?
- Straightening of the left upper border of the heart
- Pulmonary artery enlargement
- Enlargement of the upper pulmonary lobes veins
- Esophagus shift
- Kerley B lines
PCI is in use in MS patients after ____ in order to evaluate the ___ when symptoms occur, and to follow up after the post _____
Valvular repair
return of the disease
surgery stenosis
In asymptomatic MS patients the recommended treatment is:
Prophylactic penicillin
In MS patients with light symptoms ___ and ___ have shown improvement
Sodium decreasing
Oral diuretics
In MS patients with AF, slowing down the HR have shown benefitable effect. We can prescribe the following drugs: ___, ___, ___. Prophylactic therapy with ____ is also necessary
BB
CCB (diltiazem, verapamil)
Digitalis
Anti coagulation
What are the indications for valvotomy in MS patients?
- Symptomatic patients with NYHA II-IV
2. Valve >1.5 cm2
Ideal MS patients for valvotomy are patients with ____, ____, and ____. We should also notice there is no ____.
Minimal calcification on the anulus
Flexible cusps
Structurally preserved valve area
Thrombus in the left atrium
How will you define a successful valvular surgery/repair?
Lowering the pressure gradient on the MV in 50% or increasing the valve’s area X2
In about ___ of MS patients after surgical therapy, a follow up surgery will be needed within ___ from the procedure.
50%
10 years
What does PBMC stands for?
Percutaneous balloon mitral commissurotomy
