Mitral Stenosis Flashcards
what is the commonest cause of mitral stenosis?
rheumatic heart disease - streptococcal antigens secondary to bacterial infection cross-react with the valve tissue, causing damage
what are the causes of mitral stenosis?
- rheumatic heart disease
- mitral annular calcifcation (age-related)
- congenital mitral stenosis
- mucopolysaccharidosis
- carcinoid syndrome
- systemic disease
what are the typical symptoms of mitral stenosis?
- dyspnoea
- haemoptysis
- palpitations - AF is common in patients with MS
- chest pain
- thromboembolism
- hoarseness
- peripheral oedema/abdominal discomfort
why do patients experience hoarseness in mitral stenosis?
compression of the recurrent laryngeal nerve
what are the examination findings in mitral stenosis?
- mitral facies (malar flush)
- low volume pulse
- atrial fibrillation
- elevated JVP
- tapping, non-displaced apex beat (palpable S1)
- R ventricular heave
- inspiratory crepitations
what are the auscultation findings in mitral stenosis?
diastolic murmur
* loud S1
* loud P2 with pulmonary hypertension
* open snap heard at apex
* graham-steell murmur (early diastolic murmur) - only if pulmonary regurgitation is present
describe the murmur heard in mitral stenosis
diastolic murmur
* low pitched rumble, most prominent at apex
* loudest in expiration
* heard best with patient lying on left side
* heard best using stethoscope bell (low frequency)
how do you diagnose mitral stenosis?
echocardiogram
what is seen on ECG in mitral stenosis?
- p-mitrale (broad notched p wave due to left atrial enlargement)
- right ventricular hypertrophy
- right axis deviation
- atrial fibrillation
what is the management of mitral stenosis?
- balloon valvuloplasty
- percutaneous mitral valvotomy
- open valve repair/replacement
what do you do if the patient is asymptomatic?
review every 6 months
what are the complications of mitral stenosis?
- atrial fibrillation
- thromboembolism
- pulmonary hypertension
- dilated left atrium
- decompensated heart failure
