Mitral Stenosis Flashcards
Describe how big the mitral valve can be and its relationship to symptoms.
- Normal valve area is 4-6 square centimeters
- Symptoms are rare if the valve is >2cm2
- Exertional symptoms may occur if the valve is <2cm2
- Rest symptoms occur if the valve is < 1-1.5cm2
Discuss the heart changes of Mitral Stenosis
- Commisural fusion is the hallmark
- ELEVATION OF LA pressure
- Funnel shaped valve
- Myocardial contractility is normal (LV function is preserved)
Physical exam findings of Mitral Stenosis
- Malar Flush
- Palpable S2 or Opening snap
- Loud S1 (early in course)
- Diastolic low pitched rumble at apex
- Dyspnea
Complications of Mitral Stenosis
- Left Heart Failure
- Right Heart Failure
- A-fib
- Thromboembolism
- Hemoptysis
What is associated with Mitral Stenosis?
- Rheumatic Heart Disease
2. Mitral Annular Calcification
Discuss Mitral Annular Calcification
- Deposits on fibrous ring
- Risk of thrombi and endocarditis
- Usually doesn’t affect valve function
EKG findings of Mitral Stenosis
LAE in sinus rhythm
Right axis deviation
Coarse atrial fibrillation
Chest X-ray findings of Mitral Stenosis
LAE
Cephalization of pulmonary vasculature
Enlarged pulmonary artery
How is Mitral Stenosis diagnosed?
Doppler Echo
What are the 3 approaches to treated mitral stenosis?
- Controlling heart failure
- Heart Rate control
- Percutaneous Balloon Valvotomy
- Surgery
How do you control heart failure in a Mitral stenosis pt?
Diuretics to remove excess blood volume
How do you control heart rate in a Mitral Stenosis pt?
Beta blockers, CCB
Which pts are eligible for Percutaneous Mitral Balloon Valvotomy?
Pt is symptomatic with severe MS (<1.5cm2) and a pliable valve in the absence of LA thrombus or moderate to severe MR.
Which pts are eligible for surgical repair of the mitral valve?
- Pts with symptomatic severe MS and have a contraindication for PBMV
- Pts with symptomatic severe MS and undergoing other cardiac surgery
Which is preferred, Mitral valve repair or replacement?
REPAIR
