Mitral Stenosis

Question 1

Main cause of MS?

Answer 1

Rheumatic fever

Question 2

MS pathophysiology?

Answer 2

Valve narrowing leads to increased RA pressure , and RA enlargement.
Causes AF, pulmonary oedema, pulmonary hypertension, RVH, TR and RHF eventually

Question 3

Symptoms of MS

Answer 3

Dyspnoea 
Fatigue
Chest pain 
AF (palpitations + emboli)
Haemoptysis (rupture of bronchial veins)

Question 4

Signs of MS?

Answer 4

AF
Malar flush
Tapping apex beat
JVP may be raised
Loud S1
Rumbling MDM @ apex (decrescendo-crescendo)

Question 5

Clinical indicators of severe MS?

Answer 5

Mitral facies
Opening snap closer to 2nd heart sound (indicates higher LA pressures forcing early mitral valve opening)
RVF (sign of decompensation)

Question 6

What causes malar flush/mitral facies?

Answer 6

LA volume overload
CO falls
Leading to backpressure + vasoconstriction

Question 7

Echo characteristics of MS?

Answer 7

Valve orifice <1cm^2
Elevated pulmonary artery pressures > 50mmHg
Pressure gradient >10mmHg

Question 8

Treatment of MS?

Answer 8

Rate and rhythm control of AF
Optimise RFs
Repair or replace valve if severe symptomatic.
Valvotomy
Percutaneous balloon valvuloplasty (if valve still pliable)