Mitral Stenosis

Question 1

what is the definition of mitral stenosis

Answer 1

mitral valve narrowing causing obstruction of blood flow from LA to LV

Question 2

what is the aetiology of mitral stenosis

Answer 2

rheumatic heart disease (90%)
calcification of mitral valve leaflets
congenital mitral stenosis
SLE
rheumatoid arthritis
endocarditis
atrial myxoma

Question 3

what is the most common valvular heart disease in pregnancy

Answer 3

mitral stenosis

Question 4

what is the epidemiology of mitral stenosis

Answer 4

no. of cases decreasing as rheumatic fever decreases in industrialised countries

Question 5

what is the history associated with mitral stenosis

Answer 5

asymptomatic
fatigue
SOB on exertion/orthopnea
palpitations related to AF

Question 6

what is the history associated with rheumatic fever in mitral stenosis

Answer 6

asymptomatic latent phase post initial rheumatic fever
symptoms 15-20yrs later
severe symptoms a further 10yrs later

Question 7

what are the rare symptoms observed in mitral stenosis

Answer 7

cough
haemoptysis
hoarseness (compression of left laryngeal nerve by LA enlargement

Question 8

what would be the examination findings in mitral stenosis

Answer 8

inspection
-malar flush(CO2 retention)
pulse
-'thready'/irregularly irregular(AF)
palpation
-normal apex beat location with tapping
-parasternal heave-RV hypertrophy+pulmonary HTN
auscultation
-loud hs1 with opening snap
-mid-diastolic murmur
-evidence of pulmonary oedema (creps) if decompensated

Question 9

what investigations would be performed in suspected mitral stenosis

Answer 9

1 ECG
-normal
-broad bifid P wave(P mitrale) due to LA enlargement
-AF
-evidence of RV enlargement in severe pulmonary HTN
2 CXR
-LA enlargement
-cardiomegaly
-pulmonary congestion
-mitral valve calcification in rheumatic cases
3 echo
-assesses function and structure
-transoesophageal for better visualisation
4 cardiac catheterisation
-for severity of HF

Question 10

what is the gold standard test for mitral stenosis

Answer 10

TTE