Valve diseases - Mitral Stenosis

Question 1

Epidemiology

Answer 1

Men
Most common cause of mitral stenosis = rheumatic heart disease secondary to rheumatic fever
Ageing population

Question 2

Risk factors

Answer 2

Rheumatic fever
Untreated streptococcus infections
IV Drug use
Bicuspid valve
Diabetes,
High blood pressure,
Smoking

Question 3

Aetiology

Answer 3

RHEUMATIC FEVER -> Leaflets fuse together (commissural fusion) -> prevents seal formation
Infective endocarditis (MC = post strepyogenes infection)
Valve calcification

Question 4

Pathophysiology

Answer 4

Mitral bicuspid lumen 4-6cm2 (normal) - Sx < 2cm2
Thickening + inability of the valve = obstruction of blood flow from left atrium to left ventricle.
RHD causes mitral reactive inflammation, over years exacerbated with calcification - LA hypertrophy and chamber dilation
More chances of embolization as blood actively pumped from LA harder = more A.fib associated

Question 5

Symptoms

Answer 5

MALAR CHEEK FLUSH - association with AFib (due to stasis in LA + LA hypertrophy)
Dyspnoea
Haemoptysis (due to pulmonary oedema)
Chest pain

Question 6

Signs

Answer 6

LOW PITCHED, MID DIASTOLIC MURMUR
- loudest at APEX
- best heard on expiration with patient lying on LHS
Loud S1 snap (due to thickened valve cusps stopping each other) - closer to S2 if murmur more severe
A wave on JVP

Question 7

Diagnosis

Answer 7

CXR (LA enlarged)
ECG (A fib, p.mitrale = bifid ‘m’ shape P waves when LA enlarged
GOLD STANDARD = ECHO - Assess valve area, gradient, mobility

Question 8

Treatment

Answer 8

Surgical:
- Percutaneous balloon valvotomy (stent open mitral valve opening)
- Mitral valve replacement