Mitral Stenosis ASE video

Question 1

fish mouth appearance deformity

Answer 1

mitral stenosis

Question 2

pathology of mitral stenosis (basic)

Answer 2

LV inflow (obstruction) at level of mitral valve

impaired opening of MV during diastolic filling of the LV

Question 3

history of rheumatic fever is a big indicator that someone might have

Answer 3

mitral stenosis (although many present without a history of rheumatic fever!)

Question 4

true or false mitral stenosis more commonly affects. women

Answer 4

TRUE

Question 5

symptoms of mitral stenosis

Answer 5

left sided heart failure (normal LV contraction usually tho) (high LA pressure because obstruction)

right sided heart failure

asymptomatic until a. fib develops

exacerbated by pregnancy

Question 6

mitral stenosis is called a “disease of plateaus” WHY?

Answer 6

every 10 or so years, increasingly more alarming symptoms occur, once you reach class 3 or 4 symptoms, prognosis is grim with a 15% 10-year survival rate WITH medical therapy

Question 7

what does the heart sound like with mitral stenosis

Answer 7

opening snap and a low-pitched diastolic rumble… opening snap can disappear in SEVERE mitral stenosis.

The closer the opening snap gets to the 2nd heart sound, the more severe the mitral stenosis.

Question 8

what is malar flush?

Answer 8

pinkish-purple patches on the face/cheeks from mitral stenosis (physical exam)

Question 9

physical exam: mitral stenosis

Answer 9

peripheral cyanosis
jugular venous distension (due to pulmonary HTN)
right heart failure, loud P2
malar flush

Question 10

Example case of a patient with Mitral Stenosis

Answer 10

54 year old female, history of rheumatic fever
Dyspnea on exertion, NYHA functional class 3
PND/Orthopnea

Question 11

“doming” of anterior mitral valve leaflet, hockey-stick appearance

Answer 11

mitral stenosis in PLAX view

Question 12

Measurements for Mitral Stenosis

Answer 12

2D and TTE and TEE
- mean gradient
- planimetry on the valve (mitral valve area)
- doppler pressure half-time (allows us to calculate mitral valve area)
- color doppler methods like PISA
- continuity equation

MEASUREMENTS. required are LVOT diameter, LVOT velocity, TVI, Peak MV TVI

Question 13

what is pressure half-time

Answer 13

it is the time required for the velocity to drop to half the peak pressure

Question 14

equation for pressure half-time

Answer 14

220 / PHT = MVA

220 / pressurehalftime=mitralvalvearea

Question 15

can you calculate pressure half-time if you have the deceleration time? YES

Answer 15

pressure half-time = deceleration time x 0.29

Question 16

(acquired MS) aka

Answer 16

nonrheumatic causes of MS