Mitral stenosis

Question 1

What is mitral stenosis?

Answer 1

mitral valve narrowing causing obstruction to blood flow from LA to LV

Question 2

Describe the epidemiology of MS

Answer 2

Incidence decreasing with decrease in rheumatic fever

Question 3

List 3 causes of MS

Answer 3

Rheumatic Heart Disease
Congenital
AI: SLE, RA

Question 4

List 4 symptoms of MS

Answer 4

SOBOE orthopnoea + paroxysmal nocturnal dyspnoea.
Palpitations due to AF
Hoarseness
Haemoptysis: rupture of bronchial veins due to raised LA pressure.

Question 5

What may make a previously asymptomatic woman develop symptoms of MS?

Answer 5

Pregnancy due to increase in blood volume

Question 6

List 5 signs of MS

Answer 6

Malar flush
Laterally displaced tapping apex beat.
RV heave.
Atrial fibrillation.
Signs of RV failure inc raised JVP, hepatomegaly, ascites + peripheral oedema.

Question 7

What is heard on auscultation in MS?

Answer 7

Rumbling mid diastolic murmur
Best heard on left with bell of stethoscope
Loud S1
Opening snap in early diastole.
Increased length of murmur indicates severity

Question 8

Describe an ECG seen in MS

Answer 8

May be NORMAL
May see p mitrale (broad bifid p wave due to LA hypertrophy)
May see AF
Evidence of RV hypertrophy may be seen if there is severe pulmonary HTN

Question 9

Give 4 features seen on a CXR in MS

Answer 9

LA enlargement
Cardiac enlargement
Mitral valve calcification (in rheumatic cases)
Pulmonary oedema (Kerley A + B lines)

Question 10

What is echocardiography used for in MS?

Answer 10

Assess severity + consequences of MS + extent of anatomical lesions.
Evaluates pulmonary artery pressures, associated MR, concomitant valve disease + LA size.

Question 11

What may give a better view of the heart in MS?

Answer 11

Transoesophageal echocardiogram (TOE)