Mitral valve stenosis

Question 1

Causes of Mitral Stenosis

Answer 1

Usually causes by Rheumatic fever, other causes are rare.

Other causes
Annular calcification,
Carcinoid heart disease,
Mucoploysaccharidoses

Question 2

What are the morphologies of Mitral stenosis

Answer 2

Chrodae fusion, thickening, shortening

Cusps, thickening, calcifying

Commisures, fusing.

Question 3

Mitral stenosis symptoms

Answer 3

Pulmonary congestion and hypertension and associated symptoms
Hemoptysis
May lead to pulmonary regurgitation

Mitral facies/Malar flush in some.

Fatigue
Palpitation

Atrial dilation, Fibrillation

Question 4

Auscultation of MS

Answer 4

Mid DIASTOLIC crescendo decrescendo murmur

Low pitched, Rumbling, WITH Opening SNAP

Best heard at Apex of heart, loudest on expiration, and when patient lays on their left side.

Palpable thrill may be felt at apex.

Question 5

Pulse in mitral stenosis

Answer 5

Lower amplitude pulse,

In atrial fibrillation, irregularly irregular pulse.

Increased A waves in JVP. A for Atrial contraction

Question 6

Mitral stenosis indications for treatments

Answer 6

Well tolerated generally. Indication for invasive fix:
NYHA class 3 and 4 patients.
Mitral valve area less than 1.5cm2
Pulmonary Artery Systolic pressure above 60 mmHg
PCWP above 25 mmHg
Valve gradient is above 15mmHg during exercise

Asymptomatic: Treat with antihypertensives, diuretics, and beta blockers, and salt/fluid restriction.
Anticoagulants if A fib.

Symptomatic –> treat with balloon valvulotomy as 1st option,
Conta’s:
Valves are too calcified,
Diameter less than 1.5cm2.
Significant Mitral Regurgitation is presen.t

If valvulotomy can’t be done, the replacement surgery.