Mitral Stenosis

Question 1

Define

Answer 1

Mitral valve narrowing causing obstruction to blood flow from the left atrium to the ventricle

Question 2

Epidemiology

Answer 2

Incidence in decreasing in industrialised countries due to declining incidence of rheumatic fever

Question 3

Symptoms

Answer 3

Fatigue
􏰀 Progressive SOB on exertion or lying down
(orthopnoea), paroxysmal nocturnal dyspnoea
􏰀 Palpitations (related to AF)
􏰀 CP
􏰀 Systemic emboli
Normal mitral valve orifice area is ~4-6cm2
Symptoms usually begin when the orifice becomes <2cm2

Question 4

Signs

Answer 4

Peripheral/facial cyanosis
􏰀 Malar flush on cheeks (↓cardiac output)
􏰀 Thready, low volume pulse
􏰀 ±Irregularly irregular pulse (if AF)
Laura Tan CARDIO 6
􏰀 Undisplaced tapping apex beat
􏰀 Parasternal heave (RV hypertrophy and pulmonary HTN)
􏰀 Loud first heart sound with opening snap
􏰀 Rumbling mid-diastolic murmur – heard best in expiration with pt on left side
􏰀 Evidence of pulmonary oedema in lung auscultation (f decompensated)

Question 5

Investigations

Answer 5

ecg, cgest cray, echo

Question 6

Causes

Answer 6

Most common: rheumatic heart disease (90%)

Also: congenital, SLE, RhA, endocarditis, atrial myxoma Degenerative calcification (in elderly)