Mitrial Stenosis

Question 1

True or false.

Mitral stenosis is the most common valvular lesion in pregnancy

Answer 1

True

Question 2

True or false

Patients may be asymptomatic until physiologic changes of Pregnancy unmask the lesion

Answer 2

True

Question 3

What is the treatment for mitral stenosis for symptomatic patients during pregnancy

Answer 3

Balloon valvulotomy

Question 4

Complications of mitral stenosis

Answer 4

Pulmonary edema, atrial fibrillation, supraventricular tachycardia

Thromboembolism Can develop as a result of left atrial dilation which may present as a stroke

Question 5

At what mean gestational age does 60% of patients have their initial episode of pulmonary edema

Answer 5

30 weeks gestation

Question 6

When are symptoms usually seen in mitral stenosis

Answer 6

Mitral valve area less than 2cm2

Question 7

Definition of moderate mitral stenosis

Answer 7

1 to 1.5cm2 valve area

Question 8

Work up and management for mitral stenosis

Answer 8

Echocardiogram to establish severity of stenosis and left atrial size

Electrocardio gram to exclude atrial fibrillation from an enlarged left atrium

With auscultation hear loud first heart sound an opening snap and rumbling diastolic murmur

Question 9

List for things to avoid with mitral stenosis in pregnancy

Answer 9

Avoid tachycardia it decreases diastolic ventricular filling time

Avoid fluid overload it may cause atrial fibrillation, pulmonary Edema and right ventricular failure

Avoid decrease in systemic vascular resistance and hypotension because it decreases cardiac output

Avoid increase in pulmonary vascular resistance via hypoxia

Question 10

Goal of therapy in mitral stenosis

Answer 10

Prevent tachycardia with pain management and beta blockers goal for heart rate is less than 100 bpm

Maintain left ventricular filling to overcome obstruction because inadequate preload may not be able to overcome obstruction and may lead to inadequate left ventricular filling and decreased cardiac output

• use diuretics to treat pulmonary edema
• digoxin to treat atrial fibrillation

Anticoagulation with left atrial dilation or if chronic atrial fibrillation

Question 11

Labor and Delivery considerations in Mitral stenosis

Answer 11

Tocolytic agents that cause tachycardia a contraindicated such as terbutaline

Hemodynamic monitoring for severe mitral stenosis

Consider assisted second stage of labor

Reserve cesarean for obstetric indication

Epidural is except a bowl but avoid abrupt sympathetic blockade Which can decrease preload