Mitral Stenosis

Question 1

Mitral Stenosis Pathophysiology

Answer 1

• Structural abnormality of the valve
• Increases left atrial and pulmonary arterial pressure
• Pulmonary hypertension can lead to RV failure and tricuspid regurgitation
• RV hypertension can cause raised JVP, liver congestion, ascites and oedema
• Static blood flow in left atrium can cause thromboembolism

Question 2

Mitral Stenosis Aetiology

Answer 2

• Rheumatic stenosis (more common in developing countries)
• Degenerative calcification
• Congenital
• Inborn errors of metabolism
• SLE
• Rheumatoid arthritis (inflammation builds up in CVS)

Question 3

Mitral Stenosis Presentation

Answer 3

-Can feel asymptomatic for years and then present with a gradual decrease in activity
-Progressive breathlessness is main symptom
-Pulmonary oedema can be triggered by onset of AF
-AF may be presenting feature
-Haemoptysis due to rupture of bronchial veins from raised left atrial pressure
Signs
-Malar flush
-Raised JVP
-Displaced apex
-Right ventricular heave

Question 4

Mitral Stenosis Ix

Answer 4

• CXR may show atrial enlargement and interstitial oedema
• ECG (AF, hypertrophy)
• Echo is main method used to assess severity and consequences

Question 5

Mitral Stenosis Management

Answer 5

• Asymptomatic patients should be followed up yearly
• Percutaneous mitral commisurotomy is treatment of choice
• Medical therapy
• Diuretics or long-acting nitrates can be used to alleviate dyspnoea
• Anticoagulate if AF

Question 6

Mitral Stenosis Complications

Answer 6

• Pulmonary hypertension
• Dilated left atrium
• AF
• Thromboembolic events

Question 7

Mitral Stenosis Prognosis

Answer 7

• Ten year survival is good

- Survival less than 3 years for those with pulmonary hypertension