Mitral Stenosis

Question 1

Define Mitral Stenosis

Answer 1

Narrowing of the opening of the mitral valve

Question 2

Aetiology of Mitral Stenosis

Answer 2

Rheumatic fever (Streptococcal infection=> chronic scarring)
Congenital mitral stenosis
Carcinoid syndrome
SLE
Mitral annular calcification due to ageing
Amyloidosis

Question 3

Epidemiology of Mitral Stenosis

Answer 3

rheumatic fever - developing countries and indigenous people | more common in females + tropical countries

Question 4

Symptoms of Mitral Stenosis

Answer 4

Asymptomatic

Fatigue
SOB, orthopnoea
Palpitations or chest pain
Dysphagia 
Red cheeks/flushing
PNDm haemoptysis, hoarseness, lower limb swelling, ascites

Question 5

Signs of Mitral Stenosis on examination

Answer 5

Malar fluse or facial cyanosis
Low volume, thready pulse OR AF (irregularly irregular)
Tapping (non-displaced) apex beat
Mid-diastolic murmur ever the mitral valve (accentuated by left lateral position) + opening snap + loud S1

Decompensated => Bi-basal lung crops (pulmonary oedema)

Question 6

Investigations for Mitral Stenosis

Answer 6

Echo - Diagnosis, shows narrowing

ECG - P-mitrale (broad, bifid P wave), may show AF, Right ventricular hypertrophy (RAD)

CXR - Left atrial enlargement (double shadow in cardiac silhouette), prominent pulmonary artery, Kerley B lines (Pulmonary oedema), mitral valve calcification