Mitral Stenosis

Question 1

What is mitral stenosis.

Answer 1

Stiffening of the mitral valve.

Question 2

What are the risk factors for mitral stenosis. (7)

Answer 2

Men are at greater risk than women. 
Rheumatic heart disease. 
Congenital.
Prosthetic valve. 
Malignant carcinoid. 
Endocarditis. 
Systemic lupus erythematosus.

Question 3

What are the symptoms of mitral stenosis. (10)

Answer 3

Dyspnoea. 
Fatigue. 
Chest pain. 
Systemic emboli. 
Haemoptysis. 
Chronic bronchitis like pictures (+ complications).
Orthopnoea. 
Paroxysmal nocturnal dyspnoea. 
Palpitations. 
Right sided heart failure.

Question 4

What are the clinical signs of mitral stenosis. (13)

Answer 4

Malar flush on cheeks (due to low CO). 
Atrial fibrillation. 
Pulmonary oedema. 
Raised JVP with a prominent a wave. 
Low volume pulse. 
Tapping apex beat. 
Left parasternal heave. 
Loud S1. 
Opening snap. 
Rumbling mid-diastolic murmur (accentuated with exertion, heard with patient on the left side). 
Stigmata of systemic embolization.
May develop tricuspid regurgitation.
Graham-Steell murmur may occur.

Question 5

What is seen on the ECG of a patient with mitral stenosis. (4)

Answer 5

Tall P waves in V1 and II.
Right axis deviation.
RV hypertrophy in pulmonary hypertension.
AF.

Question 6

What are the consequences of mitral valve stenosis. (2)

Answer 6

In order for sufficient CO to be maintained, the L atrial pressure increases and L atrial hypertrophy and dilatation occurs.
The causes pulmonary venous, arterial and R heart pressures to increase.

Question 7

When do symptoms of mitral valve stenosis occur.

Answer 7

Normal mitral valve 4-6cm.

Symptoms begin at 2cm.

Question 8

What occurs with increasing severity of mitral stenosis. (2)

Answer 8

The longer the diastolic murmur will be.

The closer the opening snap will be to S2.

Question 9

What may be seen on CXR in mitral stenosis. (3)

Answer 9

Left atrial enlargement.
Pulmonary oedema.
Mitral valve calcification.

Question 10

What investigation is diagnostic for mitral stenosis.

Answer 10

Echo.

Question 11

What are the complications of mitral stenosis. (6)

Answer 11

Pulmonary hypertension. 
Emboli. 
Pressure from large left atrium on local structures (hoarseness). 
Dysphagia. 
Bronchial obstruction. 
Infective endocarditis (rare).