Mitral Stenosis

Question 1

What are the clinical signs of infective endocarditis?

Answer 1

Janeway lesions
Oslor Nodes
Nail fold infarcts
Roth spots
Anaemia
Murmum
Fever

Question 2

What would you find on examination of the pulse in mitral stenosos

Answer 2

There may be AF
In severe mitral stenosis there may be narrow pulse prsesure with low volume indicating there is a low cardiac output state

Question 3

What does the JVP show in pulmonary hypertension

Answer 3

Systolic V Waves

Question 4

What does a malar flush signify in mitral stenosis?

Answer 4

A low cardiac output state with pulmonary hypertension

Question 5

What does an opening snap mean in mitral stenosis?

Answer 5

The opening snap indicates opening of a calcified valve - it means it is pliable. The earlier the snap, the greater the LA pressure therefore the more severe the stenosis.
HOWEVER absence of opening snap may occur also in severe mitral stenosis because the valves are no longer pliable at all

Question 6

What is a Graham Steel Murmur?

Answer 6

Pulmonary Regurgitation
Diastolic, Short
Louder in INSPIRATION
Present with other signs of pulmonary hypertension

Question 7

What is the management of mitral stenosis

Answer 7

1. With AF - rate/rhythm control, anticoagulation
2. Diuretics to decrease LA pressure
   3, Replacement/Repair

Question 8

If a patient with Mitral stenosis develops a hoarse voice, what are two things to consider

Answer 8

1. LA enlargement leading to compression of the recurrent laryngeal nerve = Ortnor’s Syndrome
2. Amiodarone therapy for AF can cause hypothyroidism

Question 9

Name three broad catagories of complications from prosthetic valves

Answer 9

1. Is the valve functioning correctly?
2. Infective Endocarditis
3. Complicatios associated with over or undercoagulation

Question 10

What are the clinical signs of pulmonary hypertension

Answer 10

Parasternal Heave
Parasternal Thrill
Systolic V Waves in the JVP
Loud pulmonary component to the second heart sound

Question 11

In prosthetic valve replacement how can you indentify the site through the sound?

Answer 11

1. Often closing click is loudest (except Starr Edwards, two equal sounding clicks)
2. Loudest click WITH carotid pulse = first heart sound = mitral
3. Loudest click AFTER carotid pulse = second heart sound = aortic

Question 12

If you see a midline sternal scar what other scar should you look for?

Answer 12

Saphenous vein or radial artery harvest scars

Question 13

What are the types of valve replacement?

Answer 13

Prosthetic
Xenograft (porcine)
Homograft (cadaveric)

Question 14

What patients should receive a bioprostethic valve?

Answer 14

Considered where:

• anticoagulation would be contraindciated
• pt’s life expectancy is shorted than lifespan of prostehsis
• pts >70 have slower rate of degeneration of biovalves.

Question 15

What are the complications of prosthetic valves?

Answer 15

Endocarditis
Haemolysis
Thromboembolism
Valve Dysfunction

Question 16

What are three causes of anaemia in a pt with prostethic valve?

Answer 16

Haemolysis
Endocarditis
Bleeding from anticoagulation

Question 17

What would left lateral chest scar suggest?

Answer 17

Previous Mitral valvotomy

Question 18

If there is a mitral valve prosthesis - what should your presentation address?

Answer 18

1. Evidence of previous surgery
   2, Is the valve functioning well - ie is there signs of mitral regurgitation (leaky valve)
2. Is there PULMONARY HTN persisting (common)

Question 19

What are the signs a mitral prosthesis is not functioning properly?

Answer 19

1. Displaced and thrusting apex

2. Systolic murmur into the axilla (MR)

Question 20

What is Carvello’s Signs?

Answer 20

The murmur of TR (pansystolic) is louder in inspiration

Remember TR means pulmonary hypertension

Question 21

If you here a systolic murmur in someone with a mitral prosthesis -what could it be?

Answer 21

1. Dysfunctioning valve - MR

2. Persisting pulmonary hypertension - TR

Question 22

What are the indications for valve replacement in mitral stenosis?

Answer 22

Pulmonary congestion
Pulmonary hypertension
Haemoptysis
Recurrent thromboemobolic events on anticoagulation