Mitral Stenosis Flashcards
Causes:
What is the main cause for all valve disease?
Rheumatic valve disease is the COMMONEST cause of mitral stenosis.
What is it?
It can also cause a rash called erythema marginatum before rheumatic fever, which affects the trunk and inner surfaces of arms and legs
Calcification
Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever.
What is the difference between rheumatic fever and rheumatic heart disease?
RF is an inflammatory disorder caused by a Group A strep throat infection.
It affects the connective tissue of the body, causing temporary, painful arthritis and other symptoms.
In some cases rheumatic fever causes long-term damage to the heart and its valves. This is called rheumatic heart disease.
Symptoms:
What are 3 breathing symptoms they have?
What colour sputum do they have?
Why could they get haemoptysis?
What type of arrhythmia may occur?
Why could you get hoarseness?
SOB
Orthopnoea
PND
Pink and frothy - pul oedema
Bronchial vein rupture due to pulmonary HTN
AF due to the strain on the left atrium
Compression of the recurrent laryngeal nerve
Signs:
Type of murmur
Where is it heard?
What do you ask the patient to do to accentuate it?
Do you use the D or B?
What happens to S1?
Why do they get a tapping beat?
Why do they get malar flush?
Mid-diastolic murmur heard at the apex
Roll onto the left lateral side
Heard better with the bell as it is a low pitched and rumbling murmur due to low-velocity.
Loud S1 due to thickened valves requiring more systolic pressure to close - LOUD S1 SNAP
Upon auscultation of an individual with mitral stenosis, the first heart sound is usually loud and maybe palpable (tapping apex beat) because of increased force in closing the mitral valve.
Malar flush is a plum-red discolouration of the high cheeks classically associated with mitral stenosis due to the resulting CO2 retention and its vasodilatory effects.
Investigations:
ECG:
- What arrhythmia may be seen?
- What is P-mitrale?
- Why do you see right axis deviation as opposed to left?
CXR:
- What would they see? - 2
AF
P-mitrale - broad P-wave due to large left atrium - they have 2 peaks - look up
P-mitrale occurs when the depolarization of the right atrium and left atrium are both visible in the P wave. This is seen as a notch in the P wave and occurs when the left atrium is markedly enlarged, such as in mitral valve stenosis.
RVH - due to increased pressure on the right side of the heart as pulmonary pressure increases
Enlarged left atrium - double right heart border
Valve calcification
Management
Medical;
- What should be given for AF?
- What should be given for SOB due to pul oedema?
- What should be given to improve exercise tolerance?-
- What needs to be done annually to monitor progression?
Anticoags
Diuretics or long-acting nitrates
Beta-blockers or rate-limiting CCB’s
Echocardiogram
Surgery
What is a percutaneous balloon mitral commissurotomy?
What is a contraindication?
Other options?
Involves opening up the valves at the junction of its leaflets using a balloon catheter
Left atrial thrombosis
Open surgical commissurotomy
Valve replacement
Complications:
What causes oesophageal and recurrent laryngeal nerve compression as well as AF?
Other complications
Left atrial enlargement
Pulmonary HTN
RVF
Right sided valve disease
Infective endocarditis
