Mitral stenosis summary

Question 1

Causes and Pathophysiology of Mitral Stenosis

Answer 1

Rheumatic fever - causing autoantibodies that cause pancarditis, esp targeting valves. Mitral most common.

Question 2

Describe clinical syndromes of Mitral Stenosis

Answer 2

Back pressure in LA

10 year intervals. Rheumatic fever - signs of MS - mild symptoms - A fib - severe symptoms - death

Question 3

Symptoms of Mitral Stenosis

Answer 3

Dyspnea (Pulm. edema, orthopnea/PND),
Hemoptysis (due to chronic, cough up blood from bronchial v. rupture)
Fatigue (backup to R side)
Arrythmias (A fib. due to stretch, can cause emboli)

Question 4

Signs and Physical findings of Mitral Stenosis

Answer 4

Heart sounds: 
Left:
-opening snap, S1 louder, filling rumble. 
-As it progresses: Snap and S1 diminish, snap gets closer to S2, and rumble gets longer 
Right:
-parasternal heave (larger RV)
-S3 / S4
-tricuspid regurgitation etc.

Question 5

Key lab tests and findings of Mitral Stenosis

Answer 5

EKG - LA and RV larger, A fib
Echo - see severity of valve and functions
CXR - calcified valve, Kerley B lines and edema, enlarged heart
Cardiac catheterization - measure pressures

Question 6

Tx of Mitral Stenosis

Answer 6

rheumatic fever ➔ Treat & prevent recurrences
signs of MS ➔ Prevention of recurrences
mild symptoms ➔ Drugs (slow rate, diuretics)
Afib / moderate ➔ Consider balloon/surgical commissurotomy
severe ➔ Valve replacement surgery
Rx for mild: Diuretics, Coumadin (for A fib.), ß blockers (slow HR, more time in diastole)

Question 7

Indications for surgery of Mitral Stenosis

Answer 7

A fib/moderate - consider balloon/commissurotomy

Severe - valve replacement