Mitral Stenosis

Question 1

Define mitral stenosis

Answer 1

Narrowing of mitral valve -> obstruction to blood flow from LA to LV

leads to progressive left atrial enlargement and pulmonary hypertension

Question 2

What are the causes/ risk factors of mitral stenosis?

Answer 2

• Rheumatic heart disease (90%)
• Congenital
• SLE
• RA
• Endocarditis
• Atrial myxoma
• streptococcal infection
• amyloidosis

Question 3

What are the symptoms of mitral stenosis?

Answer 3

• Asymptomatic
• Fatigue
• SOBOE
• Orthopnoea
• Palpitations (AF)
• hoarseness of voice

Question 4

What are the signs of mitral stenosis?

Answer 4

• Malar flush
• Thready, irregularly irregular pulse – AF
• Tapping apex beat
• Right ventricular heave (RVH and pulmonary HTN)
• Loud S1 with opening snap
• Mid-diastolic murmur with presystolic accentuation

Question 5

What are the investigations for mitral stenosis?

Answer 5

• ECG - atrial fibrillation; left atrial enlargement; right ventricular hypertrophy
• CXR - double right heart border indicating an enlarged left atrium; prominent pulmonary artery; Kerley B lines
• trans-thoracic echocardiography - hockey stick-shaped mitral deformity
• trans-oesophageal echocardiography - presence of possible left atrial thrombus
• cardiac catheterisation - high left atrial pressure, low left ventricular pressure, and low cardiac output
• dynamic exercise testing - pressures increase with exercise; pulmonary capillary wedge (PCW) >25 mmHg or pulmonary systolic pressure >60 mmHg