Mitral Stenosis Flashcards
What is the number one cause of MS?
rheumatic
What causes Mitral Stenosis?
- Rheumatic
- Severe mitral annulus Ca+ deposition
- Left Atrial Myxoma
- Congenital
Rheumatic is most common in?
women ages 30-50 and when pregnant due to increase volume flow
What is Left Atrial Myxoma?
benign tumor that can grow in LA and cause functional stenosis. Typically attached to IAS
How does Congenital MS appear?
Parachute MV where leaflets are tethered together
What are the symptoms/signs of MS?
- overload to pulmonary vasculature ( DOE, hemoptysis, PND, orthopenea)
- inadequate cardiac output (chest pain, fatigue, syncope)
- overload to right side and cava
What is the #1 symptom of MS?
DOE/dyspnea
What is the 2nd common symptom of MS?
hemoptysis (sputum)
Name the symptoms of overload to pulmonary vasculature
- DOE
- cough
- sputum
- rale/cackles
- PND
- orthopnea
What does it mean when there’s an overload to pulmonary vasculature?
LA is pressure and volume overloaded which moves back to pulmonary veins into pulmonary vasculature
What are the M MODE findings of MS?
1.Thickened leaflets and apparatus
2. Decreased E-F slope, a wave, D-E & increased EPSS
3. Early diastolic notch on IVS
4. Anterior motion of posterior leaflet during opening (parallel motion)
5. LAE
What are the 2D findings of MS?
- Thickened leaflets and apparatus
- Anterior motion of posterior leaflet during opening
- Hockey stick or diastolic doming of AMVL
- Decreased valve opening and fusion of commissures during PSAX
- LAE
- Candle flame jet in diastole (color)
What are OTHER findings of MS?
- fusion/fibrosis of the mitral chordae in rheumatic MS
- Coexisting valvular disease in rheumatic (MV first, AV then TV)
- Associated MR
- Possible A Fib
- Possible LA thrombus found in LAA
- Small or protected LV and AR (chambers receiving inadeq volume)
- Signs of pulmonary hypertension
What is the most obvious sign of HTN?
RVH eventually RVE
Why do we see Atrial Fibrillation with MS?
LA stretches and disrupts the conduction system; also irritates left atrial tissue which causes A Fib
What Auscultations are heard with MS?
- Low pitched diastolic rumble heard at APEX
- Opening snap -only heard when MV is stenosed, not in a healthy heart
- Loud S1
What are the treatments of MS?
- balloon or surgical commissurotomy (definitive)
- MV Replacement with prosthetic valve (definitive)
- manage pt. waiting on definitive treatment with medications
Who would be considered candidates for balloon commissurotomy?
have thin, mobile leaflets with little Ca+ & little to none subchordal involvement
Who would NOT be considered candidates for balloon commissurotomy?
if moderate MR
What occurs during a balloon or surgical commissurotomy
Separate the fused commissures
What kind of medications are given to patients that are waiting for definitive treatment?
- To treat CHF
- Control arrhythmia
- Antibiotics for recurring rheumatic fever
- Prophylactic antibiotics
- Anticoagulants to prevent clot
What ways do we determine MS severity?
- E-F Slope
- MVA via Planimetry
- MPG
- MVA via PHT
- MVA by Continuity Equation
- MVA via PISA
What is an ABNORMAL measurement for E-F Slope?
LESS than 7 cm/s
What measurement indicates severe for E-F Slope?
LESS than 3 cm/s
What are the NORMS for MVA?
Normal?
Mild?
Moderate?
Severe?
Normal: 4.0 - 6.0 cm²
Mild: > 1.5 - 2.5 cm²
Moderate: 1.0 - 1.5 cm²
Severe: < 1.0 cm²
What are the NORMS for MPG?
Mild < 5mmHg
Moderate 5- 10 mmHg
Severe > 10 mmHg
MVA via PHT Equation?
MVA cm² = 220 / PHT
MVA by Continuity Equation?
MVAcm² = .785 x LVOTd² x VTI lvot /
VTI mv
MVA via PISA (proximal isovelocity surface area) EQUATION
MVAcm² = 6.28 x r² x pre orifice velocity /
Orifice velocity
How do you see RV pressure/volume overload in:
2D PSAX?
M MODE?
-“D” shaped LV
- paradoxic septal motion
What does paradoxic septal motion mean?
timing or direction of contraction is off
Whats a LIMITATION of using MVA via PHT?
- poor apical window
- difficult in A Fib
What is LUTEMBACHERS SYNDROME?
combination of atrial septal defect and mitral stenosis
- congenital or acquired
What happens with Lutembachers Syndrome?
blood flows to the RA through the ASD instread of going backward into the pulmonary veins, avoiding pulm, hypertension
