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ANKI Cardiovascular > [6] Mitral Stenosis > Flashcards

[6] Mitral Stenosis Flashcards

1
Q

What happens when the mitral valve area goes below 2cm2?

A

The valve causes an impediment of the flow of blood into the left ventricle, causing a pressure gradient across the mitral valve

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2
Q

What causes the pressure gradient caused by mitral stenosis to increase?

A
  • Increased heart rate
  • Increased cardiac output
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3
Q

What happens as the pressure gradient in mitral stenosis increases?

A

The amount of time necessary to fill the left ventricle with blood increases, until eventually the left ventricle requires atrial kick to fill with blood

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4
Q

What happens when the heart rate goes above a certain point in mitral stenosis?

A

The diastolic filling period is insufficient to fill the ventricle with blood, and so pressure builds up in the left atrium

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5
Q

What does the pressure build up in the left atrium in mitral stenosis cause?

A

Pulmonary congestion

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6
Q

What are the causes of mitral stenosis?

A
  • Rheumatic fever
  • Calcium deposits
  • Congenital defects
  • Lupus
  • Radiation to chest
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7
Q

What are the symptoms of mitral valve stenosis?

A
  • Shortness of breath, especially with exertion or when lying down
  • Fatigue, especially during increased physical activity
  • Oedema
  • Palpitations
  • Dizziness or fainting
  • Haemoptysis
  • Angina
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8
Q

What is involved in the diagnosis of mitral valve stenosis?

A
  • Examination
  • ECG
  • Chest x-ray
  • Echocardiography
  • Cardiac catheterisation
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9
Q

What are the examination findings of aortic stenosis?

A
  • Malar flush
  • Atrial fibrillation-characteristic pulse
  • May be raised JVP
  • Tapping apex beat
  • Might have right ventricular heave
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10
Q

What might the ECG show in aortic stenosis?

A
  • Atrial fibrillation
  • P-mitrale - the presence of broad, notched P waves in lead II
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11
Q

What is P-mitrale a sign of?

A

Atrial enlargement

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12
Q

What might the CXR show in mitral stenosis?

A
  • Left atrial enlargement (double shadow in right cardiac silhouette)
  • Pulmonary oedema
  • Mitral valve calcification
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13
Q

What are the indications for cardiac catheterisation in mitral valve stenosis?

A
  • Previous valvotomy
  • Signs of other valve disease
  • Angina
  • Severe pulmonary hypertension
  • Calcified mitral valve
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14
Q

What are the options in the management of mitral valve stenosis?

A
  • Management of atrial fibrillation, including rate control and anticoagulation
  • Percutaneous balloon mitral valvuoplasty
  • Mitral valve commissurotomy
  • Mitral valve replacement
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15
Q

What are the roles for medical therapy in mitral valve stenosis?

A
  • Alleviate associated dyspnoea
  • Improve exercise tolerance
  • Anticoagulation
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16
Q

What drugs can be used to alleviate associated dyspnoea in mitral valve stenosis?

A

Diuretics or long-acting nitrates

17
Q

What can be used to improve exercise tolerance in mitral valve stenosis?

A
  • Beta-blockers
  • Heart rate-regulating calcium channel blockers
18
Q

When is anticoagulant therapy indicated in mitral stenosis?

A
  • In patients wtih either pernament or paroxysmal atrial fibrillation
  • When there has been a prior embolism, or a thrombus is present in the left atrium
19
Q

Which patients should be considered for a percutaneous balloon mitral valvuoplasty?

A

Symptomatic patients with severe mitral stenosis, or those with pulmonary hypertension

20
Q

What happens in a percutaneous balloon mitral valvuloplasty?

A

A catheter is placed into an artery in the arm or groin, and guided to the stenotic valve. Once in position, a balloon is inflated to widen the valve, improving blood flow. The balloon is then deflated and removed

21
Q

What is the limitation of percutaneous balloon mitral valvuloplasty?

A

The procedure may have to be repeated over time, or may not be successful and symptoms persist

22
Q

What should be done if a percutaneous balloon mitral valvuloplasty is not successful and symptoms persist?

A

Surgery should be considered early, unless there are definite contraindications

23
Q

What is commissurotomy?

A

Open heart surgery, in whcih calcium deposits and other scar tissue is removed from the valve

24
Q

When might commissurotomy need repeating?

A

If mitral valve stenosis reoccurs

25
Q

What are the complications of mitral valve stenosis?

A
  • Pulmonary hypertension
  • Dilated left atrium
  • Atrial fibrillation
  • Thromboembolic events
  • Right heart failure
  • Rheumatic fever
  • Infective endocarditis

ANKI Cardiovascular (24 decks)

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