Blonder - Mitral Stenosis Flashcards
For the most part, clinically significant mitral stenosis is only due to what?
Inactive rheumatic heart disease in the adult
In rheumatic heart disease, how often is the mitral valve involved?
Almost 100% of the time
What is the primary symptom of rheumatic heart disease with mitral valve involvement? Secondary symptom?
Primary: SOB
Secondary: fatigue
What happens to the L atrium with mitral stenosis?
Obstruction of flow from L atrium into L ventricle leads to increased pressure in L atrium. This will cause L atrium to dilate, and pressure will back up into pulmonary circuit and then into R ventricle and then R atrium.
What is a major associated symptom of mitral stenosis?
Afib
What are mitral facies?
Found in cases of mitral stenosis
purpleish-pink cheeks from reduced cardiac output and vasoconstriction
What heart sounds will be present upon auscultation of a pt with mitral stenosis?
Loud S1
Single S2 (no splitting)
Opening snap that follows S2 ( interval between A2 and OS will be very short in severe disease)
Mid diastolic murmur (rumble) heard at apex with pre-systolic accentuation if pt in NSR
What will happen to the mid-diastolic murmur if the pt is in NSR?
At the end of diastole, when the atria contract, there will be a pre-systolic accentuation of murmur. This is because of the increase in volume of blood being pushed across the valve.
THIS WILL BE ON THE EXAM
Besides mitral stenosis, what else can produce a diastolic rumbling murmur?
Pulmonary hypertension (as a result of mitral stenosis)
Caused by Graham Steell murmur from pulmonic valve regurgitation (insufficiency)
What will mitral stenosis produce on EKG?
L atrial enlargement producing a bifid P wave in lead 2 (called P mitrale)
RVH
Afib
What x-ray findings will be present in a pt with mitral stenosis?
L atrial enlargement
R ventricular hypertrophy
Pulmonary congestion
Enlarged pulmonary artery
What is the gold standard exam for evaluating mitral stenosis?
Echocardiography
