Mitral stenosis Flashcards
How is it defined?
A narrowing of the mitral valve to < 2cm2 from 4-6 cm2
It prevents blood from flowing from the LA to LV causing a build up of pressure in the LA
Causes of mitral stenosis?
- RHD
- congenital
- systemic disease such as lupus, rheumatoid arthritis
Investigations
ECG-PR>0.12s CXR: cardiomegaly, fibrosis, LA enlargement ECHO cardiac magnetic resonance cardiac catherisation -Blood tests
How does it develop?
- Leaflets fuse together= commissural fusion
- Reduced blood flow from LA to LV
- Build up of blood in the LA
- Blood flows back into the pulmonary circulation and can lead to oedema and congestion
- this can cause stagnation of blood from the RV and therefore lead to a thrombus
Symptoms
1-Problems swallowing as the oesophagus is compressed by the increased size of the left atrium
2-Dyspnoea
3- Systemic embolisation due to AF
4- Haemoptisis-rupturing of small vessels
5-Chest pain
Signs
1-Pulmonary hypertension-build up of pressure in the pulmonary circulation
Increased pressure in RV
RV hypertrophy as it becomes more difficult to pump blood to the lungs
2-AF: Increased pressure and volume in the atrium
Dilates the pacemaker cells
More irritable
R/L atria do not contract as effectively- blood stagnates
EXAMINATION:
-Malar flush
-normal pulse
-prominent a wave in JVP
-RV heave
-murmurs:
opening SNAP as valve open
diastolic rumble as blood flows in
Treatment
TAVI- replacement of valve using microsurgery Mitral valve replacement Valvotomy- opening of valve Diuretics Anticoagulants with those with AF Reduce Na intake
what does the severity depend on?
gradient and blood flow between chambers
Cause for RV heave
Due to increased hypertrophy in right ventricle due to back flow of blood into pulmonary circulation
Where are the sarcomeres added in concentric hypertrophy?
In parallel to the inner layers of the heart
