Mitral stenosis

Question 1

Define what mitral stenosis is?

Answer 1

A mechanical obstruction in the left atrium output due to thickening/calcification of the mitral valve

Question 2

Define the aetiology of mitral stenosis

Answer 2

Rheumatic fever ( by strep )
Congenital
Systemic conditions: 
-lupus erythematosus 
-rheumatoid arthritis

Infective endocarditis

• Strep viridans can cause subacute endocarditis but cure chance is higher
• Strep aureus can cause acute endocarditis

Question 3

Define the pathology behind mitral stenosis? (in terms of heart and pressure)

Answer 3

Blood accumulate in the LA
A-V P increase
LA P increase
Pulm vein P increase
Pulm resistance increase
Pulm artery P increase so pulmonary hypertension 
RV increased dilation
LA hypertrophy with tricuspid/pulm regurg

Question 4

What is the size of an abnormal mitral valve (stenosis)?

Answer 4

Under 2cm

Question 5

Which two factors can greatly increase the severity of mitral stenosis?

Answer 5

If trans-valvular P gradient and flow rate increase

Question 6

Name 6 main symptoms

Answer 6

Dyspnoea:
-pumonary odema

Haemoptosis
-rupture of the veins

Systemic embolisation
-enlarged LA or appendage

Infective endocarditis

Chest pain

Hoarsness:
- left recurrant laryngeal nerve

Fatigue

Question 7

Name 5 signs

Answer 7

Mitral facies 
Pulse = normal
JVP = a wave is prominent 
Tapping apex beat and diastolic thrill
RV heave

Question 8

Name the 5 types of investigations

Answer 8

ECG:
p wave is more than 0.12s
RV hypertrophy
Atrial fibrillation

CXR:
LA hypertrophy
odema

Echocardiograph:
LA Hypertrophy
Thickening/scarring of the leaflets
Fusion of the commissures

Cardiac magnetic resonance

Cardiac catheritisation
*not used often

Question 9

Name 3 treatments

Answer 9

Diuretics and Na restriction:
-decreases odema as plasma volume decreases

Anticoagulants:
-treat atrial fibrillation and allows stroke volume to restore and the ventricular rate to be controlled

Question 10

What are the 2 interventional treatments?

Answer 10

Valvotomy (balloon vs surgical)

MVR