Mitral Stenosis

Question 1

Define mitral stenosis

Answer 1

Normal mitral valve orifice area is 4-6cm2, symptoms usually begin when orifice becomes <2cm2

Question 2

What ECG signs does mitral stenosis exhibit? Explain what they are

Answer 2

AF or

If in sinus rhythm p-mitrale which are bifid P-waves due to enlarged LA

Question 2

How do you management mitral stenosis?

Answer 2

If AF - rate control and warfarin

Diuretics

Balloon valvuloplasty

Open mitral valvotomy or valve replacement

Question 2

What are some complications of mitral stenosis?

Answer 2

Pulmonary hypertension

Emboli

Pressure from LA on local structures - hoarseness (recurrent laryngeal nerve), dysphagia, bronchial obstruction,

Infective endocarditis

Question 4

How is it best to hear mitral stenosis murmur on auscultation?

Answer 4

On expiration with patient on their left side

Question 6

What is the presentation of mitral stenosis?

Answer 6

Symptoms: Dyspnoea, fatigue, palpitations, chest pain, systemic emboli, haemoptysis, chronic bronchitis-like picture

Signs: Malar flush on cheeks (due to reduced CO), low volume pulse, +/- AF, rumbling diastolic murmur

Question 7

What tests are used to diagnose mitral stenosis? And what would they show?

Answer 7

ECG: AF, p-mitrale

CXR: Left atrial enlargement, pulmonary oedema, mitral valve calcification

Echo