Mitral Stenosis - Blonder SRS

Question 1

What is clinically significant MS due to in the adult?

Answer 1

Only caused by inactive rheumatic heart disease in the adult.

Question 2

Although not of great significance, what else can rarely cause mitral stenosis?

Answer 2

Mitral annular calcifications can lead to MS - largely due to aging process.

Question 3

Rheumatic fever is a disease of?

Answer 3

Childhood and young adults, particularly in populations deprived of antibiotics (3rd world, abused populations, etc)

Question 4

Rheumatic heart disease affects what proportion of patients with RF?

Answer 4

1 in 3

Question 5

How often is the mitral valve involved in RHD?

Answer 5

NEarly 100% of the time

Question 6

What are the valvular presentations we see with rheumatic heart disease?

Answer 6

40% have isolated MV involvement

40% have MV and aortic involvement

20% have MV, Aortic valve, and tricuspid valve involvement

Question 7

What organism causes RF?

Answer 7

Group B strep

Question 8

What are the symptoms of RHD?

Answer 8

1. DOE (dyspnea on exertion)
2. PND (paroxysmal nocturnal dyspnea)
3. Orthopnea
4. fatigue
5. hemoptysis
6. atrial fibrillation
7. thromboembolism
8. chest pain (from pulmonary HTN)

Question 9

What are the symptoms in Mitral stenosis due to?

Answer 9

Symptoms are due to the obstruction of flow from the LA to the LV through the MV. This increases the pressure in the LA, pulmonary vasculature back into the RV and RA. It is the resistance to blood flow that increases the pressure.; The heart always tries to maintain the flow (CO), and thus the pressure rises secondarily.

Question 10

A very common sequalea of MS, atrial fibrillation reduces CO by two mechanisms. What are they?

What can this precipitate?

Answer 10

1. Loss of atrial contribution to LV filling
2. Increase in HR both of which reduce LV filling

Can frequently precipitate APE (acute pulmomary edema)

Question 11

What does the patients face look like in MS?

Answer 11

•Mitral facies-pink purple cheeks (maxillary) from decrease in CO and vasoconstriction

Question 12

Describe the auscultation findings in mitral stenosis

Answer 12

• Increased S1
• Single S2
• Opening Snap, follows S2, severe shortens the A2-OS interval
• Mid diastolic murmur (rumble), heard at apex, with pre systolic accentuation (if in NSR).

Question 13

If the opening snap of the mitral valve comes a long time after the A2 sound (long A2 - OS interval), then?

Answer 13

severe MS

Question 14

What will you hear at the apex of the heart in a patient with mitral stenosis?

Exam topic

Answer 14

Middiastolic murmur (rumble), with presystolic accentuation

Question 15

What else can cause a diastolic murmur in mitral stenosis?

Also a test question

Answer 15

Pulmonary HTN caused pulmonic valve insufficiency.

Question 16

What will you see on chest x-ray in MS?

Answer 16

•CXR-LAE, RVH, pulmonary congestion, enlarged PA (hypertension)

Question 17

What is the gold standard for MS diagnosis? What components matter?

Answer 17

•Echocardiography is now the gold standard.

• PA pressures,
• mitral gradients (mean and peak),
• CO,
• SV
• MVA are all standard.