Mitral stenosis

Question 1

Define:

Answer 1

Mitral valve narrowing causing obstruction of blood flow from left atria to ventricle.

Question 2

Aetiology/risk factors:

Answer 2

Most common cause is rheumatic heart disease (90%)

Rare causes:
Congenital mitral stenosis 
Mucopolysaccharidoses
Endocardial fibroelastosis 
Prosthetic valve
SLE 
Rheumatoid arthritis
Endocarditis 
Atrial myxoma

Question 3

Epidemiology:

Answer 3

Declining incidence as there is a decline in the incidence of rheumatic heart disease

Question 4

Symptoms:

Answer 4

may be asymp

Fatigue

exertional dysponea

chest pain

orthopnea

palpitations (AF)

systemic emboli

dysphagia if severe

rare chronic bronchitis like symptoms:

• cough
• haemoptysis
• hoarseness due to compression of the recurrent laryngeal nerve

Question 5

Signs:

Answer 5

peripheral cyanosis

MALAR FLUSH

irregularly irregular pulse if AF

low volume pulse

apex undisplaced + tapping

parasternal heave

loud s1 sound with snap

MID DIASTOLIC MURMUR HEARD AT THE APEX AND ON BETTER ON EXPIRATION WHEN PATIENT IS LYING ON THEIR SIDE.

Pulmonary oedema - bilateral basal crackles

Question 6

Investigations:

Answer 6

Echo - this is diagnostic (Transoesophageal gives a better view) –> assesses functional and structural impairment

ECG - normal but may show signs of AF, p mitrale (left atrial hypertrophy ) and right ventricular hypertrophy signs

CXR - left atrial enlargement, cardiac enlargement, pulmonary oedema and mitral valve calcification if rheumatic

cardiac catheterisation - severity of HF