Mitral stenosis

Question 1

What is mitral stenosis?

Answer 1

Occurs when there is obstruction through the mitral valve during diastole.

Question 2

Most common cause of mitral stenosis?

Answer 2

Most common cause is rheumatic heart disease.

Question 3

Symptoms of mitral stenosis?

Answer 3

Typically presents with gradual exertional dyspnoea and reduced exercise tolerance.

Palpitations - AF is common in patients

Question 4

Signs of mitral stenosis?

Answer 4

Mid-diastolic murmur best heard at the apex.

Tapping apex beat

Malar flush

Elevated JVP

Question 5

Investigations for mitral stenosis?

Answer 5

CXR: may show evidence of pulmonary oedema and left atrial enlargement.

ECG: may show right axis deviation, right ventricular hypertrophy

Echocardiogram: main method and is used to assess the severity and consequences of mitral stenosis.

Question 6

Medical management for mitral stenosis?

Answer 6

Patients with AF should be anticoagulated and rate-controlled.

Diuretics and beta blockers can provide symptomatic relief in decompensated states due to illness.

Medical management is NOT an alternative to surgery.

Question 7

Surgical management for mitral stenosis?

Answer 7

For symptomatic patients, there are 3 options:
- Balloon valvuloplasty - only appropriate if valve is pliable and non-calcified.

• Percutaneous mitral valvotomy - for patients with moderate disease
• Open valve repair/replacement - for patients with severe disease who are not too high risk for surgery.