Murmurs

Question 1

In mitral stenosis, what is the typical murmur heard?

Answer 1

Loud S1 with an opening snap, rumbling mid-diastolic murmur.

Question 2

Where is the murmur in mitral stenosis best heard?

Answer 2

Patient lying on L hand side in held expiration.

4th-5th intercostal space in mid clavicular line

Question 3

What is the most common cause of mitral stenosis?

Answer 3

Rheumatic heart disease following rheumatic fever

Question 4

What is the normal diameter of the mitral valve orifice?

Answer 4

4-6cm

Question 5

At what size orifice do symptoms usually start occuring in mitral stenosis?

Answer 5

<2cm

Question 6

What symptoms typically occur in mitral stenosis?

Answer 6

Dyspnoea
Fatigue
Palpitations
Chest pain
Systemic emboli
Haemoptysis
Orthopnoea

Question 7

What signs typically occur in mitral stenosis?

Answer 7

Malar flush
Low volume pulse
AF
Tapping, non-displaced apex beat
Rumbling mid-diastolic murmur with loud S1 and openeing snap

Question 8

What test is diagnostic for mitral stenosis? What does it typically show?

Answer 8

ECHO - hockey stick shaped mitral deformity

Question 9

What could CXR show in mitral stenosis?

Answer 9

LA enlargement
Pulmonary oedema
Mitral valve calcification

Question 10

What could ECG show in mitral stenosis?

Answer 10

AF

RVH

Question 11

What are the indications for cardiac catheterisation in mitral stenosis?

Answer 11

Previous valvotomy
Signs of other valve disease
Angina
Severe pulmonary HTN
Calcified mitral valve

Question 12

How is mitral stenosis managed?

Answer 12

Usually watch and monitor unless severe and symptomatic.

At that stage duiretic (furosemide or bumetanide) or balloon valvotomy is indicated

Question 13

What are the complications of mitral stenosis?

Answer 13

AF
Stroke
Warfarin-induced haemorrhage
Infective endocarditis (rare)