Mitral Stenosis Flashcards
Symptoms of left sided heart failure
PNSD, orthopnea and exertions dyspnea
Less freq;! Haemopysis, hoarseness
Most common cause of mitral stenosis
Rheumatic heart disease
Pathology of mitral stenosis
Leaflet thickening, nodularity, and commissars fusion - fish mouth shape
Natural hx of mitral stenosis
Until symptoms show- latent period of 20-40years
Anothr 10 years before symptoms become disabling
Once disabling 10 year survival is 0-15%
Mechanism of tapping apex beat
Accentuated first heart sound
Opening snap indicates
Caused by opening of mitral valve, indictates the leaflets are still pliable . Only tips are calcified
Complications
Left atrial hypertrophy and a fib Systemic embolisation Pulmonary hypertension Tricuspid regurg Right heart failure
ECG evidence
Bifid p wave
A fib
Left atrial enlarge
Right ventricular hypertrophy
CXR
Congested upper lobe veins
Double silhouette from enlarged atrium left
Kerley b lines
Echo
Tool of choice
Mgmt
Asymptomatic in sinus ; prophylaxis against endocarditis
Mild symptoms; diuretics to reduce left strispressure
A fib; rate control and anti coags
Moderate to severe: mechanical relief of stenosis- usually percut mitral ballon valvuloplasty
Closed mitral valvotomy
Open repair
Valve replace
Indications for surgery
Severe symptoms of pulmonary congestion and significant mitral stenosis
Recurrent thromboembolic events despite anti coags
Rarer causes of mitral stenosis
RA
SLE
malignant carcinoid
Congenital stenosis
Mimics mitral stenosis
Left Atrial myxoma
Ball valve thrombosis in left atrium
Ortner syndrome
Hoarseness die to paralysis of left vocal cord from atrial hypertrophy
