Mitral stenosis

Question 1

What is the pathophysiology of mitral stenosis?

Answer 1

Orifice smaller than 2cm leads to increase in AV pressure gradient causing left atrial pressure increase and increase in pulmonary venous and capillary pressure
Leads to pulmonary oedema, LVH and dilation

Question 2

What are the symptoms of mitral stenosis?

Answer 2

No symptoms till orifice moderately stenosed
Dyspnoea
Haemoptysis

Question 3

What are the signs of mitral stenosis?

Answer 3

Mitral facies
Normal pulse, prominent JVP
Diastolic thrills 
RV heave
Diastolic murmur

Question 4

What investigations are used in mitral stenosis?

Answer 4

CHEST XRAY - enlarged left atrium, calcified mitral valve, pulmonary oedema
ELECTROCARDIOGRAM - bifid p wave, atrial fibrillation
ECHOCARDIOGRAM - left and right atrial and ventricle size and function
CMR - Mitral valve anatomy
CARDIAC CATHETERISATION - if existing cardiac problems

Question 5

What is the treatment for mitral stenosis?

Answer 5

Don’t intervene until serious
Diuretics and restriction of sodium intake
Anticoagulant to prevent atrial thrombus
Valvotomy - open, closed, transeptal balloon
Mitral valve replacement - necessary if mitral regurgitation also present