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Cardiovascular System > Mitral valve stenosis > Flashcards

Mitral valve stenosis Flashcards

1
Q

What is it?

A

Narrowing of the valve < 2cm causing blood flow obstruction from LA to LV

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2
Q

Why does heart dilate?

A

Because the heart muscle is weakened and cannot pump effectively, commonly due o ischaemia (less coronary blood flow)

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3
Q

What are 3 main causes of mitral stenosis?

A

Rheumatic heart disease
Congenital mitral stenosis
Systemic conditions

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4
Q

What are the symptoms of mitral stenosis?

A 
Pul. oedema 
Haemoptysis 
Systemic embolisation 
Infective endocarditis 
Hoarseness - compression of L recurrent laryngeal 
Dyspnoea 
Chest pain
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5
Q

What are signs on clinical examination?

A 
Mitral facies: rosy cheeks due to low cardiac output and perfusion 
Normal pulse 
JVP - prominent a wave 
Tapping apex beat and diastolic thrill 
RV heave
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6
Q

How does MS lead to low Cardiac output?

A

Low LV EDV -> low preload -> low SV -> low CO

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7
Q

What investigations should be carried out?

A 
ECG
Cardiac catheterisation
CXR 
ECHO 
Cardiac MRI
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8
Q

What are medical treatments for mitral stenosis?

A

Diuretics
Lower Na intake (for HPT)
Sinus rhythm restoration
Anticoagulation (for AF)

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9
Q

What happens to CO, SV and HR?

A

EDV is lower in LV therefore preload decreases and SV lowers.

HR increases to compensate and try to deliver more blood -> tachycardia - which also decrease the diastolic filling time

Overall decrease in CO

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10
Q

How does tachycardia in M stenosis cause AF?

A

The stretching and enlargement of LA can cause heart rhythm irregularity in which the upper chambers of heart beat chaotically and too quickly

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11
Q

What are 2 systemic conditions which causes mitral stenosis?

A

Systemic lupus erythematosus

Rheumatoid arthritis

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12
Q

What happens to the A-V pressure gradient in mitral stenosis?

A

Increase

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13
Q

What happens to the LA pressure in mitral stenosis?

A

Increase as blood builds up in the chamber

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14
Q

What happens to the pulmonary venous and capillary pressure in mitral stenosis?

A

Increases, as blood, instead of going in to the ventricle, flows back in to the pulmonary circulation

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15
Q

What happens to pulmonary vascular resistance?

A

Increase

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16
Q

What happens to pulmonary arterial pressure and what can it cause?

A

PaP increases and pulmonary HPT develops

17
Q

What happens to the right side of the heart?

A

Dilatation because of tricuspid regurgitation and pulmonary regurgitation

18
Q

What happens to LV pressure and systolic function?

A

LV pressure and systolic function normal

19
Q

What does the mitral stenosis severity depend on?

A

Trans-valvular pressure gradient

Trans-valvular flow rate (increase in HR or CO)

20
Q

When might heart rate increase, causing the severity of mitral stenosis to increase?

A

Exercise
Acute illness
Pregnancy
Atrial fibrillation

21
Q

What will cause dyspnoea in mitral stenosis?

A

On mild exertion

From pulmonary oedema

22
Q

Why might mitral stenosis cause haemoptysis?

A

When there is rupture of thin-walled veins in the lungs from increased pressure

23
Q

Why might mitral stenosis cause systemic emboli? And what can this lead to?

A

As left atrial and left auricle enlargement can lead to emboli which can lodge in the carotid artery, causing a stroke

24
Q

Why might mitral stenosis cause hoarsness of voice?

A

Compression of the L recurrent laryngeal nerve

25
Q

What does an elevated a wave of the JVP indicate?

A

Resistance to right atrial emptying

26
Q

Why might a rv heace be palpable in mitral stenosis?

A

Increased pulmonary pressure causes RV hypertrophy

27
Q

What will be seen on a CXR with mitral stenosis?

A

LA enlargement

28
Q

What will be seen on an ECHO with mitral stenosis?

A

Thickening and scarring of leaflets

Fusion of commissures

29
Q

Explain why it’s a diastolic thrill that is heard?

A

During diastole, the mitral valve is open to fill the ventricle, so stenosis of that valve causes a murmur heard after S2 heart sound

30
Q

What will be seen on an ECG of mitral stenosis?

A

RVH

P>0.12sec

31
Q

What are interventional treatments for mitral stenosis?

A

Balloon valvotomy - widens valve

Mitral V. replacement

Cardiovascular System (37 decks)

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