FN: Mitral Stenosis Flashcards
1
Q
Causes
A
Rheumatic Fever
Prosthetic Valve
Congenital
2
Q
Pathophysiology
A
- Valve narrowing –> increased left atrial pressure –> loud S1 and atrial hypertrophy –> AF
- –> pulmonary oedema and PHT –> loud P2, PR
- –> RVH –left parasternal heave
- -> TR –> large v waves
- -> RHF –> increased JVP, oedema, ascites
3
Q
symptoms
A
Dyspnoea Fatigue Chest pain AF --> palpitations + emboli Haemoptysis: rupture of bronchial veins
4
Q
Signs
A
- Symptoms manifest when orifice backpressure + vasoconstriction)
- JVP may be raised late on
- Left parasternal heave (RVH secondary to PHT)
- Apex: Tapping (palpable s1), non-displaced
- Heart sounds
- Murmur
5
Q
JVP may be raised late on
A
Prominent a waves: PTH
Large v waves: TR
Absent a waves: AF
6
Q
Heart sounds
A
Loud S1
Loud P2 (if PHT)
Early diastolic opening snap
7
Q
Murmur
A
Rumbling MDM Apex eft lateral position in end expiration Radiates to the axilla ± Graham Steell murmur (EDM secondary to PR)
8
Q
Clinical Indicators of Severe MS
A
Mitral facies
Longer murmur
Opening snap closer to 2nd heart sound - high LA pressure forcing valve open early
Decompensation
9
Q
Complications
A
Pulmonary HTN Emboli: TIA, CVA, PVD, ischaemic collitis Hoarseness dysphagia (oesophageal compression Bronchial obstruction
10
Q
Ortner’s Sign
A
Hoarseness rec laryngeal N. palsy
11
Q
Investigations
A
Bloods ECG CXR Echo + Doppler Cardiac Catheterisation
12
Q
Bloods done
A
FBC U + E LFTs Glucose Lipids
13
Q
ECG
A
AF
P mitrale ( if in sinus)
RVH with strain: ST depression and T wave inverion in V1 - V2
14
Q
CXR
A
LA enlargement
Pulmonary oedema: ABCDE
Mitral valve calcification
15
Q
Echo + Doppler
A
Severe MS (AHA 2006 Criteria) Use TOE to look for left atrial thrombus if intervention considered
