Mitral valve stenosis Flashcards
1
Q
Mitral valve stenosis: def
A
- mitral valve doesn’t open enough -> gets harder for the blood to go from the atrium to the ventricle, so harder to fill the ventricle
2
Q
Mitral valve stenosis: causes
A
- Rheumatic fever. Most often. Here, instead of having an inflammation causing the leaflets to not form a good enough seal (like in mitral valve regurgitation), the leaflets can fuse together, called commissural fusion
- non rheumatic causes: congenital, carcinoid, endocarditis, iatrogenic
3
Q
Mitral valve stenosis: What are the consequences of the commissural fissure
A
- because it’s harder for the blood in the atrium to go to the ventricles -> volume of blood in the left atrium increases -> leading to higher pressures in the left atrium -> dilation of the atrium -> blood flows back to the pulmonary circulation -> pulmonary hypertension -> RV hypertrophy -> RHF
4
Q
Mitral valve stenosis: symptoms and complications
A
- pulmonary congestion
- pulmonary edema
- dyspnea
- orthopnea
- palpitation
- fatigue
- hemoptysis
- RHF symptoms
- increased risk of A-fib (because the wall of the left atrium dilates and stretch the pacemaker cells running through the wall making it more irritable)
- Increased risk of thrombus formation -> can get into the systemic circulation
- compress neighbor structures, like esophagus, which results in patients having difficulties swallowing: dysphagia
5
Q
Mitral valve stenosis: diagnosis
A
- auscultation: diastolic decrescendo murmur occurring after an opening snap. Because of the high pressures in the left atrium, when it opens during the diastole -> it makes a “snap” sound
- ECG: p-mitrale, RVH, A-fib
- CXR: LVH, enlarged left atrium, right side even depending on the severity
- Echo
- Stress echo
6
Q
Mitral valve stenosis: Treatment
A
- in asymptomatic patient: keep patients in sinus rhythm: BB, CCB, anticoagulants
- in symptomatic patient:
.if A-fib -> BB, CCB, digoxin, anticoagulants
.if severe -> surgery. Based on ACC/AHA guidelines. Percutaneous mitral ballon valvotomy (PMBV), closed/open valvotomy, replacement
