MITRAL STENOSIS

Question 1

What can u hear in auscultation in patient with MS ?

Answer 1

Loud S1

Loud P2 (in cases of pulmonary HTN )

Opening snap

Mid diastole rumbling murmur

Question 2

DDx of MS

Answer 2

• LA Myxoma
• Cor triatrium
• prosthetics valve thrombus
• Austin flint murmur (in sever AR d/t vibration of anterior mitral leaflet )
• ASD
• Tricuspid stenosis

Question 3

Pathophysiology in relation to clinical presentation (symptoms)

Answer 3

•increased LA pressure &Volume ;

• Ortner’s Syndrome
• increased pulmonary vein pressure>pulmonary vascular changes (PHTN ,heamoptysis,RVH,TR,may lead to R SIDE HF )
• increase pulmonary vein pressure >transduction of fluid to pulmonary intrstetial space >increased work of breathing >progressive dyspnea on exertion &pulmonary Eden’s in fever cases )

*AF
•decrease LV filling > decrease CO
>easy fatigability and syncope

Question 4

Systemic examination px findings:

Answer 4

Chest : Bi-basal creptation of lung congestion/pulmonary edema

Abdomen :as cites and hepatomegaly if RVF

Bilateral peripheral edema if RV failure

Question 5

MS causes

Answer 5

Female >Male
1- RHD *most common cause

2-mitral annular calcification (old age , women atherosclerosis ,renal failure ,hyperparathyroidism)

3-congenital(infant and children,rare )
:double orifice mitral valve , parachute mitral valve

4-systemic causes:
•radiation therapy
•IE
•Inflammatory ( SLE,Rheumatic arthritis ,carcinoid syndrome)
•mucopolysaccaharidoses(metabolic disorder from absence or malfunctioning lysosomal enzyme that break down glycosaminoglycan leading to their accumulation in tissue )

Question 6

Symptoms of MS :

Answer 6

• Exertional Dyspnoea (in sever pulmonary Edema)
• cough
• palpitation (AF the most common Arrhythmias in MS)
• systemic embolisation d/t AF

•Ascites and peripheral edema

• recurrent chest infection
• haemoptysis
• ortner’s syndrome
• in pregnancy

Question 7

ECG FINDINGS SIGNS:

Of ms

Answer 7

-In sinus rhythm:
•signs of La enlargement:

P MITRAL ( broad bid is p wave in lead II & Terminal negative component to the p wave in V1 lead

•sings of pulmonary HTN :

P PULMONALE(RA hypertrophy)(p wave amplitude >2.5mm in lead II ) & RVH (R to S ratio >1 ( prominent R) in lead V1

-commonly AF

Question 8

What can u palpate in patient with MS ?

Answer 8

Tapping apex beat

Diastolic thrill at the aber in lateral decubitus position

Parasternal heave and palpable P2 in 2ed intercostal space (these signs of PHTN)

Question 9

MS investigations :

Answer 9

• ECH is procedure of choice
  • rheumatic MS features: hockey stick , fish mouth appearance of mv

*ECG :
•if sinus rhythm :LA enlargement,RA&RV enlargement

•AF

*CXR: LA enlargement,LA appendage enlargement.pulmonary Venus congestion,pulmonary edema

Question 10

Physical examination findings(general) of MS:

Answer 10

•mitral Davies ,peripheral cyanosis
•sign of strike /peripheral ischemia
•look for signs of IE if present
•v/s: Pulse :if AF irregularly irregular
JVP: raised with prominent A wave in PHTN
In AF absence of A wave

Question 11

Apathiphysiology of MS

Answer 11

When orifice LV)

> •increase in LA size
•Increase In LA pressure
•LA pressure transmitted to pulmonary veins

Question 12

What type of murmur Heard- in MS ?

*Best Heard- where?

Associated lesions ?

Answer 12

Mid-Diastolic Rumbling murmur(low pitched , the murmur increases by exercise )

Presystolic accentuation of murmur if patient in sinus rhythm (d/t):
Atrial contraction

Best Heard at : at the Apex in lateral decubitus position

Associated lesions: TR , Grahm steel murmur (pulmonary regurgitation d/t PHTN)