Mitral Stenosis Flashcards
What is mitral stenosis?
Valvular obstruction to flow from the left atrium to the left ventricle
What are the causes of mitral stenosis?
- Rheumatic heart disease (most common)
- Congenital
- Degenerative calcification
- Malignant carcinoid
What is the pathophysiology of MS that leads to symptoms?
- Resistance to blood flow between the LA and LV leads to an increase in the pressure gradient
- Pressures increase in LA
- This predisposes to AF and atrial thrombosis
- This also predisposes to raised pulmonary pressures leading to right sided heart failure
What are the symptoms of MS?
- Symptoms usually occur when orifice is <2cm^2
Pulmonary hypertension
- Dyspnoea
- Haemoptysis (vascular congestion ruptures veins)
- Chronic bronchitis
Large left atrium causing compression -
- Hoarse voice (recurrent laryngeal nerve)
- Dysphagia (oesophagus)
- Bronchial obstruction
- Fatigue, palpitations, chest pain
What is the murmur associated with MS?
Rumbling mid diastolic murmur, with patient lying on left side with the bell of the stethoscope
What signs are associated with MS?
- AF signs
- Mitral facies (malar flush)
- Right ventricular heave (PH)
Right sided heart failure - - Raised JVP
- Peripheral oedema
- Hepatomegaly
What will a CXR show in MS?
- Left atrial enlargement (double heart boarder)
- Splayed trachea
- Prominence of the atrial appendage
What will an ECG show in MS?
- AF
- P-mitrale (shows LA enlargement, a broad notched wave with a negative component in V1)
- Right hypertrophy (RAD, tall R wave in V1)
What is the diagnostic test for MS?
- Transthoracic echocardiogram
What is the management for MS?
If AF is present, treat as this
- Diuretics to reduce preload and pulmonary venous congestion
Surgical -
- Percutaneous mitral commissurotomy (PMC), eg balloon valvuloplasty is preferred
- Valve replacement
