Mitral Stenosis

Question 1

Clinical Signs (face, pulse, apex, thrill/heave, auscultation)

Answer 1

Malar flush
Irregular pulse if AF
Tapping apex
Left parasternal heave if PHTN
Loud S1, opening snap followed by mid diastolic murmur heard at apex in left lateral position on expiration

Question 2

Causes

Answer 2

Rheumatic
Senile degeneration
Endocarditis

Question 3

Differentials

Answer 3

Left atrial myxoma
Austin flint murmur

Question 4

How would you investigate?

Answer 4

Bedside: ECG (p-mitrale, AF)
Bloods
Imaging: CXR, TTE/TOE

Question 5

Features of severe MS (clinical and echo)

Answer 5

AF
Pulmonary HTN
Right sided heart failure
Opening snap occurs nearer A2 and MDM is longer
Valve area <1.0cm*2

Question 6

How would you manage this patient?

Answer 6

AF rate control and anti-coagulation
Diuretics if pulmonary oedema
Surgical: mitral valvuloplasty, open/closed valvotomy or valve replacement

Question 7

Prognostic factors

Answer 7

Asymptomatic - 15-20years
NYHA > II - 50% mortality at 5years