Mitral Stenosis

Question 1

Epidemiology

Answer 1

Rare in the developed world due to the decline of rheumatic valve disease

Female 3x more likely

Question 2

Pathophysiology of mitral stenosis

Answer 2

Valve narrowing leads to increased LA pressure which further leads to atrial hypertrophy and AF

Increased left atrial pressure is referred to the lungs, where it leads to congestion and the symptoms associated with it

The restricted orifice limits filling of the left ventricle, thereby limiting cardiac output

Question 3

Which condition can mitral stenosis mimic?

Answer 3

LVHF

Question 4

Main risk factors for mitral stenosis

Answer 4

Strep infection
Female gender
Prosthetic heart valve

Question 5

Clinical presentation

Answer 5

Dyspnoea on exertion
Fatigue
Chest Pain
AF
\+ve history of rheumatic fever

Question 6

Clinical signs

Answer 6

Malar flush due to decreased CO + vasoconstriction
Increased JVP
Oedema
AF
Loud S1 (tapping apex beat)
Mid diastolic murmur at mitral area in end expiration radiating to the axilla
Early diastolic ‘snap’

Question 7

Investigations to consider

Answer 7

ECG: AF, Bifid P waves, ST depression and t wave inversion in V1-2

CXR: LA enlargement, Pulm. Oedema.,

Echo + Doppler: Valve orifice <2cm^2

Question 8

Management

Answer 8

If pt is in AF: control rate first + anti-coagulate + digoxin

Diuretics provide symptomatic relief

Optimise any risk factors

Consider prophylaxis against rheumatic fever (rare)

Surgical treatment in mod-sev MS or when medical management doesn’t work

Question 9

Complications

Answer 9

Pulmonary HTN
Emboli
Hoarsness (due to compression by dilated LA)
Bronchial obstruction