258 - Mitral Stenosis

Question 1

What is the most common cause for mitral stenosis?

Answer 1

Rheumatic fever (40%)

Question 2

What are the common causes for MS (Mitral stenosis)s (6)?

Answer 2

Rheumatic fever
Congenital (parachute valve, cor triatriatum)
Severe calcification
SLE, RA
Myxoma
IE with large vegetations

Question 3

MS caused by rheumatic disease is caused by ____
leading to _____ of the valve leaflets together with ___ and ____ tissue . The end result is hardening of the leaflets and shortening of the ___ causing stenosis

Answer 3

Chronic inflammation
Thickening 
Fibrotic
calcified 
Chordae tendineae

Question 4

What is the normal valve area?

Answer 4

4-6 cm2

Question 5

What the the area of valve stenosis and severe stenosis?

Answer 5

> 2 cm2

>1.5 cm2

Question 6

Pulmonary HTN due to MS will cause ____, secondary ___ and ___ insufficiency and ____

Answer 6

Right ventricle enlargement
Tricuspid
Pulmonary valve
RHF

Question 7

MS symptoms usually appear on the ___ of life, ___ years after rheumatic injury. Once severe symptoms appear and if not treated life expectancy is __ years

Answer 7

4th
20
2-5

Question 8

The severity of symptoms is ___ with the ___ of the valve’s ____

Answer 8

In correlation
Severity
Stenosis

Question 9

What does permanent AF together with MS reflect?

Answer 9

Acceleration of clinical deterioration

Question 10

What symptoms will appear as the MS progresses?

Answer 10

Light exertion symptoms
Orthopnea
PND

Question 11

Why hemoptysis may occur with MS?

Answer 11

Increase in pulmonary vein pressure- a non fatal process

Question 12

There’s an increased risk for ___ in patients with MS, and it is a major ___ and ___ factor

Answer 12

PE
Mortality
Morbidity

Question 13

_____ will be more prevalence in MS

Answer 13

Lung infections

Question 14

In MS patients with severe ____ and ___, increased ___ and ___ may be noticed

Answer 14

Pulmonary HTN
Secondary tricuspid regurgitation
JVP
A waves

Question 15

In MS patients systemic ___ will be ___ or even ___

Answer 15

BP
Normal
Low

Question 16

In early stages of MS the __ sound will be ___ and ___

Answer 16

1st
More profound
Late

Question 17

The ___ sound will be ___ in patients with ____

Answer 17

2nd
Split
Pulmonary HTN

Question 18

During expiration in MS patients ____ may be heard medially to the ____, slightly after the ___ of the aortic valve

Answer 18

Opening snap
Apex
Closure sound

Question 19

The more the MS becomes more severe, the more time passes between the ____ and the ____

Answer 19

Opening snap of the MS

Closure of the aortic valve

Question 20

In MS patients with preserved CO, the ____ of the ____ is in direct correlation to the stenosis severity

Answer 20

Length

Murmur

Question 21

What will you see in the ECG of a MS patient? (2)

Answer 21

1. Sharp P wave on lead II
2. High P wave in V1
3. Right axis

Question 22

What is the most useful imaging tool for MS diagnosis?

Answer 22

TTE

Question 23

What are the signs for MS in CXR?

Answer 23

1. Straightening of the left upper border of the heart
2. Pulmonary artery enlargement
3. Enlargement of the upper pulmonary lobes veins
4. Esophagus shift
5. Kerley B lines

Question 24

PCI is in use in MS patients after ____ in order to evaluate the ___ when symptoms occur, and to follow up after the post _____

Answer 24

Valvular repair
return of the disease
surgery stenosis

Question 25

In asymptomatic MS patients the recommended treatment is:

Answer 25

Prophylactic penicillin

Question 26

In MS patients with light symptoms ___ and ___ have shown improvement

Answer 26

Sodium decreasing

Oral diuretics

Question 27

In MS patients with AF, slowing down the HR have shown benefitable effect. We can prescribe the following drugs: ___, ___, ___. Prophylactic therapy with ____ is also necessary

Answer 27

BB
CCB (diltiazem, verapamil)
Digitalis
Anti coagulation

Question 28

What are the indications for valvotomy in MS patients?

Answer 28

1. Symptomatic patients with NYHA II-IV

2. Valve >1.5 cm2

Question 29

Ideal MS patients for valvotomy are patients with ____, ____, and ____. We should also notice there is no ____.

Answer 29

Minimal calcification on the anulus
Flexible cusps
Structurally preserved valve area
Thrombus in the left atrium

Question 30

How will you define a successful valvular surgery/repair?

Answer 30

Lowering the pressure gradient on the MV in 50% or increasing the valve’s area X2

Question 31

In about ___ of MS patients after surgical therapy, a follow up surgery will be needed within ___ from the procedure.

Answer 31

50%

10 years

Question 32

What does PBMC stands for?

Answer 32

Percutaneous balloon mitral commissurotomy