Mitral Stenosis

Question 1

What is it?

Answer 1

When there is obstruction to flow through the mitral valve

Question 2

What causes it? (8)

Answer 2

1. Rheumatic fever
2. Degenerative calcification
3. Congenital
4. SLE
5. Rheumatoid Arthritis
6. Carcinoid Syndrome
7. Infective endocarditis
8. Amyloid deposition

Question 3

What does it cause? (3)

Answer 3

Increased left atrial and pulmonary artery pressure due to backlog of blood, and can cause right ventricular failure due to eventual pulmonary hypertension; and thromboemoli (increased stroke risk) due to static blood in the left atrium

Question 4

Symptoms (8)

Answer 4

*May be asymptomatic for years, dyspnoea, fatigue, palpitations, chest pain, paroxysmal nocturnal dyspnoea, haemoptysis (secondary rupture of bronchial veins from pulmonary hypertension)

Question 5

Signs (9)

Answer 5

Atrial fibrillation, malar flush, low volume pulse, mid-diastolic murmur, raised JVP, right ventricular heave, hepatomegaly, ascites, peripheral oedema

Question 6

What bloods would you do? (7)

Answer 6

FBC, U&E, LFT, CRP, lipids, glucose, blood cultures if new

Question 7

Other investigations (3)

Answer 7

Chest xray, ECG, ECHO

Question 8

Treatment (8)

Answer 8

Rate control for AF e.g Digoxin, Beta blocker; Warfarin/NOAC, Diuretic to reduce pre-load and ease pulmonary venous congestion; Balloon Valvuloplasty of the Mitral Valve, Open Mitral Valvostomy, Valve replacement, Oral Penicillin against recurrent rheumatic fever

Question 9

Complications (7)

Answer 9

Pulmonary hypertension, dilated left atrium, Atrial Fibrillation, Thromboembolic events, right heart failure, rheumatic fever, infective endocarditis

Question 10

Is there a good prognosis?

Answer 10

With no symptoms, 10 year survival is very good. When limiting symptoms occur, prognosis is very poor. Pulmonary hypertension means mean survival is <3 years. Prognosis is much improved in surgical repair