mitral_stenosis_flashcards
What is the definition of Mitral Stenosis (MS)?
Mitral Stenosis is a narrowing of the mitral valve orifice, impeding blood flow from the left atrium to the left ventricle, commonly caused by rheumatic fever.
What is the primary pathophysiological mechanism of MS?
In MS, the narrowed mitral valve increases left atrial pressure, causing pulmonary congestion and symptoms of left heart failure. Chronically, this can lead to pulmonary hypertension and right heart failure.
What is the epidemiology of Mitral Stenosis?
MS is most common in low- and middle-income countries due to rheumatic fever prevalence. It is more common in older adults in high-income countries due to mitral annular calcification.
What are the common symptoms of MS?
Common symptoms of MS include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, hemoptysis, and palpitations due to atrial fibrillation.
What are the main risk factors for MS?
Strong risk factors include prior rheumatic fever, female gender, and systemic lupus. Weak risk factors include ergot and serotonergic drug use.
What are characteristic findings on examination in MS?
Examination findings include a loud S1, opening snap, and a low-pitched diastolic rumble best heard at the apex with the patient in the left lateral position.
What bedside investigations are used in MS?
ECG is used to detect left atrial enlargement, right ventricular hypertrophy, and atrial fibrillation in MS patients.
What blood markers are relevant in MS assessment?
BNP may be elevated in MS patients with heart failure, and inflammatory markers may be raised if there is ongoing rheumatic disease.
What imaging modality is essential for diagnosing MS?
Transthoracic Echocardiography (TTE) is essential for assessing valve anatomy, calculating mitral valve area, and evaluating ventricular function in MS.
When is Transesophageal Echocardiography (TEE) used in MS?
TEE is used in MS to assess left atrial thrombus and in patients with complex anatomy or planning for surgery.
What special test is used to measure pressures in MS if non-invasive methods are inconclusive?
Cardiac catheterization is used to measure mitral valve area and pressures if non-invasive methods are inconclusive, particularly before surgical intervention.
What lifestyle modifications are recommended for MS?
Lifestyle modifications for MS include smoking cessation, managing comorbidities, and avoiding strenuous activities that worsen symptoms.
What are the medical management options for MS?
Diuretics help reduce left atrial pressure; beta-blockers or ivabradine manage heart rate; anticoagulation is used in patients with atrial fibrillation to prevent thromboembolism.
When is Percutaneous Balloon Mitral Valvotomy indicated in MS?
Percutaneous Balloon Mitral Valvotomy is indicated in MS patients with severe stenosis and favorable valve anatomy.
What are the risks associated with anticoagulation in MS?
Anticoagulation increases bleeding risk, especially in MS patients with atrial fibrillation or those with high thromboembolic risk.
