MITRAL STENOSIS

Question 1

Pathogenesis

Answer 1

Fusion of valvular commissures, matting of chordae tendineae, calcification of the valve -> impaired diastolic filling of the left ventricle

Question 2

DDx: Etiology

Answer 2

Rheumatic Heart Disease - MCC worldwide
Calcium

Question 3

Symptoms

Answer 3

Exertion Dyspnea - MC
Palpitations
Signs of Heart Failure

Question 4

Physical Exam Findings

Answer 4

Mid-diastolic rumbling murmur
Crescendo toward S2
Loud snapping S1
Best heard to the rt of the Apex

Question 5

Precipitants of Symptoms

Answer 5

Anemia
Infection

Question 6

Complications

Answer 6

Left Atrial Enlargement
Pulmonary Congestion
Pulmonary Hypertension
Atrial Fibrillation

Severe Disease:
Pulmonary Edema
Right Sided Heart Failure
Bronchial Vein Rupture

Question 7

Workup

Answer 7

ECG
CXR
Echocardiography (TEE best)

Question 8

ECG Findings

Answer 8

Left Atrial Enlargement: Notched or biphasic P Waves in I-II, V1-V3. V1 often biphasic.

Right Axis Deviation

Question 9

CXR Findings

Answer 9

Straigtening of Lt Heart Border
Pulmonary Congestion (late)