Mitral Stenosis

Question 1

Indicators of severity MS

Answer 1

Early opening snap
Long MDM
Pulmonary hypertension
CCF
Pulsus parvus

<1 cm2 and >10 mmHg gradient across the valve

Question 2

Causes of MS

Answer 2

** Common**

• Rheumatic heart disease
• Congenital parachute valve

** Rare**

• Calcification of mitral annulus and leaflets
• CTDs: SLE, RA
• Carcinoid (malignant)

Question 3

What is Ortner’s syndrome?

Answer 3

Hoarseness of voice from compression of the recurrent laryngeal nerve from an enlarged left atrium

Question 4

What is Lutembacher’s syndrome?

Answer 4

Association of MS with ASD

Question 5

Indications surgery for MS

Answer 5

Percutaneous mitral balloon valvotomy (PMBV)

• Preferred option above surgery
• Asymptomatic with MVA < 1.5cm and pulmonary hypertension
• Symptomatic Heart Failure
• Hemoptysis
• Recurrent thromboembolic events despite adequate anticoagulation

Surgical intervention if:

• Significant mitral regurg
• Atrial trhombus (despite warferin)
• Severe calcification
  *

Question 6

How do you diagnose rheumatic fever?

Answer 6

Duckett-Jones criteria
2 major or 1 major + 2 minor

** Major**

• Carditis, Sydenham’s chorea, SC nodules, erythema marginatum, arthritis

Minor

• Past H/o RHD, fever, arthralgia, rolonged PR, ESR, CRP
• • a h/o streptococcal infection (ASOT raised, recent scarlet fever, +GpA
    *