valvular heart - mitral stenosis

Question 1

what is MS?

Answer 1

a narrowing of the mitral valve opening

this restricts blood flow from the left atrium to the left ventricle.

Question 2

when do symptoms start?

Answer 2

when mitral valve orifice area is < 2 cm2 (normal is 4 - 6 cm2)

Question 3

what are the diseases that cause it?

what two things stay normal?

Answer 3

Rheumatic Heart Disease
Congenital Mitral Stenosis
Systemic Lupus Erythematous (SLE)
Prosthetic Valve
Malignant Carcinoid

The Left Ventricle pressure and Systolic function remain normal

Question 3

what are the 6 symptoms?

Answer 3

Chest Pain
Breathlessness
Haemoptysis
Fatigue Palpitations (if atrial fibrillation)
Systemic embolisation
Infective Endocarditis

Question 4

what 5 investigations are used to diagnose MS?

Answer 4

ECG (look for P Mitrale - this indicates left atrial hypertrophy/strain)

Echocardiography (diagnostic)

CXR (left atrial enlargement, pulmonary oedema, mitral valve calcification)

Cardiac Catheterisation

Cardiac Magnetic Resonance.

Question 4

what are the 7 signs of MS?

Answer 4

Pulse – normal or low-volume (But if Atrial Fibrillation, then an irregular pulse)

Apex beat = Tapping, and Diastolic Thill (Non-displaced)

Auscultation - Loud S1, Opening Snap, and a Rumbling Mid-diastolic Murmur which radiates to the axilla. (Heard best with the patient holding their breath in expiration, on their left side)

Hoarseness

Mitral facies - Malar Flush (red cheeks)

JVP – prominent

Right Ventricular heave

Question 5

what 5 treatments are used?

DABMA

Answer 5

Diuretics and restriction of Sodium (Na) intake

Anticoagulation (WARFARIN) : all those with Atrial Fibrillation (AF)

Balloon Valvuloplasty - a procedure that widens a narrowed heart valve

Mitral Valve Replacement

Atrial Fibrillation (AF) : Sinus Rhythm (SR) Restoration, or Ventricular rate control