mitral stenosis

Question 1

defintion of mitral stensosis

Answer 1

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

Question 2

aetiology of MS

Answer 2

most common - rheumatic heart disease (90%)

congenital mitral stenosis

SLE

rheumatoid arthritis

endocarditis

atrial myxoma (rare cardiac tumour)

mucopolysaccharidoses,

endocardial fibroelastosis

prosthetic valve

Question 3

epidemiology of MS

Answer 3

Incidence is declining in industrialized countries because of declining incidence of rheumatic fever.

Question 4

sx of MS

Answer 4

asymptomatic

Normal mitral valve orifice area is ~4–6cm2. Symptoms usually be-gin when the orifice becomes <2cm2.

fatigue

SOB on exertion/lying down (orthopnoea) - from pul hypertension

palpitations - related to AF

chest pain

systemic emboli

Question 5

Rare sx of MS

Answer 5

cough

haemoptysis

chronic bronchitis like picture

hoarseness caused by compression of L laryngeal nerve by an enlarged atrium

dysphagia from compression of oesophagus

bronchial obstruction

infective endocarditis

Question 6

signs of MS

Answer 6

peripheral/facial cyanosis - malar flush because of reduced CO

pulse - thready/irregularly irregular (AF)

palpation - apex beat undisplaced and tapping (palpable S1). Parasternal heave (right ventricular hypertrophy and pulmonary hypertension)

auscultation

Question 7

auscultation for MS

Answer 7

Loud first heart sound with opening snap (pliable valve)

Mid-diastolic murmur (presystolic accentuation if in sinus rhythm) - heard best in expiration, with pt on L hand side

Evidence of pulmonary oedema on lung auscultation (if decompensated).

Graham Steell murmur may occur

the more severe the stenosis, the longer the diastolic murmur, and the closer the opening snap is to S2.

Question 8

Ix for ms

Answer 8

ecg

cxr

echo

cardiac catheterisation

Question 9

ECG for ms

Answer 9

May be normal

broad bifid p wave (p mitrale) caused by left atrial hypertrophy

AF

evidence of right ventricular hypertrophy in cases of severe pulmonary hypertension.

progressive RAD

Question 10

CXR for MS

Answer 10

LA enlargement - double shadow in R cardiac silhouette

cardiac enlargement

pul congestion

pul oedema

mitral valve may be calcified in rheumatic cases

Question 11

echo for MS

Answer 11

diagnostic - Significant stenosis exists if the valve orifice is <1cm2/m2 body surface area

to assess functional and structural impairments

transoesophageal gives better valve visualisation

Question 12

cardiac catheterisation for MS

Answer 12

measures severity of HF

indications:

• previous valvotomy
• signs of other valve disease
• angina
• severe pul HTN
• calcified mitral valve