Mitral stenosis Flashcards
What is mitral stenosis?
Obstruction of blood flow across the mitral valve
Leads to increases in pressure within LA, pulmonary vasculature + right side of heart.
Describe the epidemiology of MS
Incidence decreasing with decrease in rheumatic fever
List 5 causes of MS
Rheumatic fever (most common)
Congenital
Carcinoid syndrome
Mitral annular calcification due to ageing
AI: SLE, RhA
Describe the nature of symptoms in MS
Typically remain asymptomatic for years until mitral valve area becomes critically reduced
List 3 symptoms of MS
Dyspnoea: increased LA pressure → pulmonary venous HTN
Fatigue
Palpitations
List 4 symptoms of late stage MS
Sx of RHF
Paroxysmal nocturnal dyspnea
Orthopnea
Haemoptysis: rupture of bronchial veins due to raised LA pressure.
What causes haemoptysis in late stage MS?
Raised LA pressure leads to rupture of bronchial veins
Ranges from pink frothy sputum to sudden haemorrhage
What can cause hoarseness in MS?
Compression of the recurrent laryngeal nerve by the enlarged LA
aka. Ortner syndrome.
What may make a previously asymptomatic woman develop symptoms of MS?
Pregnancy due to increase in blood volume
List 5 signs of MS
Malar flush
Laterally displaced tapping apex beat.
RV heave.
Signs of RV failure inc raised JVP, hepatomegaly, ascites + peripheral pitting oedema.
AF
What is heard on auscultation in MS?
Rumbling mid diastolic murmur
Best heard on left with bell of stethoscope
Loud S1
Opening snap in early diastole.
Increased length of murmur indicates severity
Describe an ECG seen in MS
May be NORMAL
May see p mitrale (broad bifid p wave due to LA hypertrophy)
May see AF
Evidence of RV hypertrophy may be seen if there is severe pulmonary HTN
Give 4 features seen on a CXR in MS
LA enlargement
Cardiac enlargement
Mitral valve calcification (in rheumatic cases)
Pulmonary oedema (Kerley A + B lines)
What is echocardiography used for in MS?
Assess severity + consequences of MS + extent of anatomical lesions.
Evaluates pulmonary artery pressures, associated MR, concomitant valve disease + LA size.
What may give a better view of the heart in MS?
Transoesophageal echocardiogram (TOE)
