Mitral Stenosis

Question 1

Mitral Stenosis: Etiology

Answer 1

1. Rheumatic (commissarial fusion) (most common)
2. Congenital (rare) (parachute)
3. Acguired (mitral annular calcification- MAC)
4. Prosthetic valve dysfunction

Question 2

Most common Mitral Stenosis etiology?

Answer 2

Rheumatic (commissarial fusion)

Question 3

Most rare Mitral Stenosis etiology?

Answer 3

Congenital (Parachute)

Question 4

Mitral Stenosis: Pathophysiology

Answer 4

1. diffuse leaflet thickening, scarring, contraction, commissural fusion, and chordae shortening and fusion
2. Associated MR may be present
3. Incread LA pressure
4. Long standing obstruction
5. decrease in CO
6. Acute rheumatic fever
7. Increased risk for endocarditis

Question 5

Mitral Stenosis: Pathophysiology:

increased LA pressure leads to?

Answer 5

LA dilation

Question 6

Mitral Stenosis: Pathophysiology:

long standing obstruction leads to?

Answer 6

Pulmonary hypertension (RV and RA enlargement)

Question 7

Mitral Stenosis: Pathophysiology

Acute rheumatic fever:

Answer 7

1. beta-hemolytic strep
2. polyarthritis
3. fever
4. subcutaneous nodules
5. carditis
6. rash

Question 8

Mitral Stenosis: physical signs

Answer 8

1. A fib is common
2. CHF symptoms
3. hemoptysis( bloody sputum)

Question 9

Mitral Stenosis murmur

Answer 9

diastolic murmur (rumble) with opening snap

Question 10

Mitral Stenosis: murmur

Answer 10

low frequency “diastolic rumble” with opening snap

Question 11

Mitral Stenosis: physical signs

CHF symptoms

Answer 11

1. dyspnea
2. fatigue
3. orthopnea
4. pheripheral edema

Question 12

Mitral Stenosis: Echo

Answer 12

1. thickened MV leaflets with decreased mobility
2. tethered MV leaflet tips (“hockey stick” presentation)
3. LA enlargement
4. signs of pulmonary hypertension in advanced disease (RAE and RVE)
5. planimeter valve area in parasternal SAX view.

Question 13

Which cardiac valve is the second most common to be affected by rheumatic heart disease?

Answer 13

aortic

Question 14

Patients with MS often develop?

Answer 14

Atrial fibrillation

Question 15

M-mode of Mitral Stenosis?

Answer 15

1. decreased E-F slope
2. anterior motion of the posterior leaflet
3. reduced amplitude of the “E” wave
4. multiple echoes

Question 16

MS patients become very symptomatic with___. Might lose ___ of ____ since they are very dependent on _____

Answer 16

• A-fib
• 50%
• diastolic filling
• atrial contraction

Question 17

AHA/ACC guidelines for mitral stenosis severity:
MVA cm sq 
mild=
mod=
severe=

Answer 17

mild= 1>1.5
mod= 1.0-1.5
severe= <1.0

Question 18

AHA/ACC guidelines for mitral stenosis severity:

Mean gradient(mmHg)
mild=
mod=
severe=

Answer 18

mild= <5
mod=5-10
severe= >10

Question 19

AHA/ACC guidelines for mitral stenosis severity:
Pulm. Artery pressure (mmHg)
mild=
mod=
severe=

Answer 19

mild= <30
mod= 30-50
severe= >50

Question 20

Mitral stenosis doppler

Answer 20

1) increased velocity and turbulence across the mitral valve
2. use pressure half time for valve area
3. MR may be present
4. measure mean transvalvular gradient

Question 21

Mitral valve area normal measurements

Answer 21

4-5 cm sq

Question 22

with atrial fibrillation mitral stenosis velocity calculations are best performed?

Answer 22

averaged over 5-10 beats

Question 23

In the PSAX view which methd is used to assess the MV area?

Answer 23

planimetry

Question 24

Deceleration time (in ms) is from?

Answer 24

peak flow to where the slope hits the baseline

Question 25

to convert deceleration time to pressure half time

Answer 25

mitral half time= deceleration time X 0.29(constant) (this is the equation)

Question 26

to convert deceleration time to mitral valve area

Answer 26

759 (constant)/ deceleration time