Mitral stenosis Flashcards
Define mitral stenosis
Mitral valve narrowing causing obstruction to blood flow from left atrium to left ventricle
Main cause of mitral stenosis
Rheumatic heart disease (90%)
Rarer causes of mitral stenosis
5
Congenital mitral stenosis SLE Rheumatoid arthritis Endocarditis Atrial myxoma
Epidemiology of mitral stenosis
incidence
Incidence declining because rheumatic fever is becoming more rare
Presenting symptoms of mitral stenosis
5
May be ASYMPTOMATIC Fatigue Shortness of breath on exertion Orthopnoea Palpitations (related to AF)
Presenting symptoms of mitral stenosis - RARE
3
Cough
Haemoptysis
Hoarseness caused by compression of left recurrent laryngeal nerve by an enlarged left atrium
Signs of mitral stenosis on physical examination
8
Peripheral cyanosis Malar flush Irregularly irregular pulse (if in AF) Apex beat undisplayed & tapping Parasternal heave (due to right ventricular hypertrophy 2º to pulmonary hypertension) Loud S1 w/ opening snap Mid-diastolic murmur Evidence of pulmonary oedema on lung auscultation (if decompensated)
Investigations for mitral stenosis
4 types
ECG
CXR
Echocardiography
Cardiac catheterisation
Investigations for mitral stenosis - ECG
4
May be normal
May see p mitrale (broad bifid p wave cause by left atrial hypertrophy)
May see AF
Evidence of right ventricular hypertrophy may be seen if there is severe pulmonary hypertension
Investigations for mitral stenosis - CXR
4
Left atrial enlargement
Cardiac enlargement
Pulmonary congestion
Mitral valve calcification (occurs in rheumatic cases)
Investigations for mitral stenosis - echocardiography
2
Assesses functional & structural impairments Transoesophageal echocardiogram (TOE) gives better view
Investigations for mitral stenosis - cardiac catheterisation
Measures severity of heart failure
