Mitral Stenosis

Question 1

Define MS

Answer 1

Obstruction of LV inflow that prevents proper filling during diastole

Question 2

What is the normal area of the mitral valve?

Answer 2

4-6 square centimetres

Question 3

When do symptoms occur?

Answer 3

When area is under 2 square centimetres

Question 4

What is the most common cause of MS?

Answer 4

Rheumatic fever, rheumatic carditis, rheumatic heart disease

Question 5

What are some more uncommon causes of MS?

Answer 5

IE, mitral annular calcification, congenital, prosthetic valve

Question 6

What are two risk factors for MS?

Answer 6

History of rheumatic fever, untreated strep infections

Question 7

How does LA dilation cause pathology?

Answer 7

It causes pulmonary congestion, leading to pulmonary HTN

Question 8

How does increased transmitral pressures cause pathology?

Answer 8

LA enlargement and atrial fibrillation

Question 9

How does pulmonary venous HTN cause pathology?

Answer 9

RHF symptoms

Question 10

How does pulmonary HTN cause haemoptysis?

Answer 10

Rupture of bronchial vessels

Question 11

What is haemoptysis?

Answer 11

Coughing up blood that has originated from the lower respiratory tract

Question 12

What are the key presentations of MS?

Answer 12

Progressive dyspnoea, haemoptysis, hoarseness, dysphagia, bronchial obstruction, apical mild diastolic rumble

Question 13

What is dysphagia?

Answer 13

Swallowing difficulties

Question 14

What are the common signs of MS?

Answer 14

Loud opening S1 snap, rumbling mid-diastolic murmur, mitral facies

Question 15

What are mitral facies?

Answer 15

Pinkish-purple patches on cheeks

Question 16

What signs are indicators of more severe stenosis?

Answer 16

Longer diastolic murmur, Shorter gap between S2 and opening snap

Question 17

What is the gold standard investigation?

Answer 17

Echo

Question 18

What would you do with an echo?

Answer 18

Assess valve mobility and area, measure pressure gradient

Question 19

What would you look for on an ECG?

Answer 19

AF, LA enlargement

Question 20

What would you look for on a CXR?

Answer 20

LA enlargement, pulmonary congestion/oedema, calcified MV

Question 21

What drugs can you prescribe?

Answer 21

Rate control drugs (Beta blockers, CCBs, digoxin), Warfarin, Diuretics

Question 22

What is the purpose of prescribing diuretics?

Answer 22

To decrease preload and reduce pulmonary venous congestion

Question 23

What are the surgical options?

Answer 23

Valve replacement, mitral valvotomy, balloon valvuloplasty

Question 24

How do you monitor MS?

Answer 24

Serial echos every 1-5 years depending on severity