Mitral Stenosis Flashcards
How is mitral stenosis defined clinically?
- Diameter of mitral valve orifice is less than 5cm2
What is the most common cause of mitral stenosis?
- Rheumatic heart disease
Identify three clinical features of mitral stenosis
- Dyspnoea
- Palpitations
- Mitral facies
- Palpitations
- Peripheral oedema
Identify two findings on auscultation
- Loud first heart sound
- Opening snap
- Rumbling mid-diastolic heard over the apex with patient on left side
Identify two findings on ECG
- Bifid P waves due to delayed left atrial activation
- Absent P waves due to AF
- Tall R waves in V1
Identify two findings on CXR
- Large left atrium
- Distended pulmonary veins
What is seen on transthoracic echocardiography?
- Hockey stick shape mitral valve deformity
What is seen on transoesophageal echocardiography?
- Left atrial thrombus
Identify a differential diagnosis of mitral stensosis?
- Atrial fibrillation
- Left atrial myxoma
What is the role of anticoagulants in therpay?
- Reduce risk of systemic embolism of left atrial thrombus
Identify three possible medications for ventricular rate control in atrial fibrillation
- Atenolol
- Diltiazem
- Digoxin
Identify three criterion for mitral ballon valvuloplasty
- Isolated mitral stenosis with no mitral regurgitation
- Non calcified valve on echocardiography
- No left atrial thrombus on TOE
Identify three criteria for mitral valve replacement
- Simultaneous mitral regurgitation
- Calcified mitral valve
- Left atrial thrombus on TOE
Identify two investigations in rheumatic fever
- Throat swabs for group A streptococci
- Antistreptolysin O titre
Identify two major manifestations of the Revised Jones criteria
- Carditis (murmurs, cardiomegaly, pericarditis, myocarditis)
- Polyarthritis
- Chorea
- Erythema marginatum
- Subcutaneous modules
Identify two minor manifestations of the Revised Jones criteria
- Fever
- Arthralgia
- Raised CRP
- Leucocytosis
- First degree AV block
- Previous rheumatic fever
How can the revised Jones criteria be used to diagnose rheumatic fever
- At least 2 major manifestations
- At least 1 major and 2 minor manifestations
What is the treatment of rheumatic fever
- Oral phenoxymethylpenicillin 500 mg four times daily
What percentage of patients with rheumatic fever will develop chronic rheumatic valvular heart disease?
- 50+ %
