Mitral Stenosis

Question 1

What is the pathology of mitral stenosis?

Answer 1

1. Obstruction at mitral valve
2. Increased pressure left atrial and left pulmonary
3. Increased pressure pulmonary capillary beds = pulmonary oedema
4. = pulmonary hypertension

Question 2

What is the aetiology of mitral stenosis?

Answer 2

Female > male Rheumatic heart disease Congenital Endocarditis SLE

Question 3

What are the symptoms of mitral stenosis?

Answer 3

SOB Orthopnoea Paroxysmal nocturnal SOB Palpitations Right-sided HF

Question 4

What are the clinical signs of mitral stenosis?

Answer 4

Malar flush Atrial fibrillation Pulmonary oedema Raised JVP Tapping apex beat Left paraphernalia heave Loud S1 Opening snap Rumbling mid diastolic murmur -heard when patient rolled on left side NB: may develop tricuspid regurgitation

Question 5

What are the investigations of mitral stenosis?

Answer 5

1. ECG
   * (Tall P waves in V1 and VII, right axis deviation and RV hyper trophy in pulmonary hypertension, AF)*
2. Echo
3. CXR
   * (Straightening of left heart border, prominent pulmonary arteries)*
4. Cardiac catheterisation

Question 6

What is the management for mitral stenosis?

Answer 6

1. Conservative
   * Yearly echo is mild/no symptoms
2. Medical

• Aimed at symptoms (diuretics, digoxin, beta-blockers
• Warfarin if AF/systemic emboli

3. Surgery

• Mitral valvotomy
• Mitral replacement