Mitral Stenosis

Question 1

What is mitral stenosis?

Answer 1

Obstruction of blood flow from the left atrium to the left ventricle, due to narrowing of the mitral valve.

Question 2

Name 7 causes of mitral stenosis.

Answer 2

• Rheumatic fever
• Congenital
• Age-related calcification
• SLE
• Rheumatoid arthritis
• Infective endocarditis
• Amyloidosis

Question 3

What is the most common cause of mitral stenosis?

Answer 3

Rheumatic fever (>95% cases)

Question 4

What are the 2 main pathologies of mitral stenosis?

Answer 4

1. Reduced LV filling leading to reduced CO

2. Increased pressure in RV leads to congestion of lungs and pulmonary oedema

Question 5

What are the symptoms of mitral stenosis?

Answer 5

FEDO:

• Fatigue
• Exertion Dyspnoea
• Orthopnoea

Rare symptoms:

• Cough
• Haemoptysis
• Hoarseness, if right heart expands and pressed on recurrent laryngeal nerve

Question 6

List 5 signs of mitral stenosis.

Answer 6

INSPECTION:
- malar flush

PALPATION:

• non-displaced apex beat
• parasternal heave

AUSCULTATION:

• mid-diastolic murmur
• loud first heart sound with opening snap

Question 7

How would you investigate mitral stenosis?

Answer 7

ECG

• may show signs of LA enlargement (broad bifid p-wave)
• may show signs of RV enlargement
• AF

CXR:

• LA enlargement/dilatation/cardiomegaly
• Prominent pulmonary artery
• Calcifiation of valve

ECHO:
- visualisation of valve (best transoesophageal)

CARDIAC CATHETERISATION:
- assess severity by measuring pressure in different chambers

Question 8

How would you manage mitral stenosis?

Answer 8

• Anti-coagulants
• Diuretics for lung congestion and HF
• Antibiotics as prophylaxis against IE
• In severe cases: valvotomy/baloon valvoplasty/valve replacement

Question 9

Name 5 possible complications of mitral stenosis.

Answer 9

• Pulmonary hypertension
• Pulmonary oedema
• Right heart failure
• AF
• Infective endocarditis