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Flashcards in FN: Mitral Stenosis Deck (19):
1

Causes

Rheumatic Fever
Prosthetic Valve
Congenital

2

Pathophysiology

1. Valve narrowing --> increased left atrial pressure --> loud S1 and atrial hypertrophy --> AF
2. --> pulmonary oedema and PHT --> loud P2, PR
3. --> RVH --left parasternal heave
--> TR --> large v waves
--> RHF --> increased JVP, oedema, ascites

3

symptoms

Dyspnoea
Fatigue
Chest pain
AF --> palpitations + emboli
Haemoptysis: rupture of bronchial veins

4

Signs

1. Symptoms manifest when orifice backpressure + vasoconstriction)
4. JVP may be raised late on
5. Left parasternal heave (RVH secondary to PHT)
6. Apex: Tapping (palpable s1), non-displaced
7. Heart sounds
8. Murmur

5

JVP may be raised late on

Prominent a waves: PTH
Large v waves: TR
Absent a waves: AF

6

Heart sounds

Loud S1
Loud P2 (if PHT)
Early diastolic opening snap

7

Murmur

Rumbling MDM
Apex
eft lateral position in end expiration
Radiates to the axilla
± Graham Steell murmur (EDM secondary to PR)

8

Clinical Indicators of Severe MS

Mitral facies
Longer murmur
Opening snap closer to 2nd heart sound - high LA pressure forcing valve open early
Decompensation

9

Complications

Pulmonary HTN
Emboli: TIA, CVA, PVD, ischaemic collitis
Hoarseness
dysphagia (oesophageal compression
Bronchial obstruction

10

Ortner's Sign

Hoarseness rec laryngeal N. palsy

11

Investigations

Bloods
ECG
CXR
Echo + Doppler
Cardiac Catheterisation

12

Bloods done

FBC
U + E
LFTs
Glucose
Lipids

13

ECG

AF
P mitrale ( if in sinus)
RVH with strain: ST depression and T wave inverion in V1 - V2

14

CXR

LA enlargement
Pulmonary oedema: ABCDE
Mitral valve calcification

15

Echo + Doppler

Severe MS (AHA 2006 Criteria)
Use TOE to look for left atrial thrombus if intervention considered

16

Severe MS (AHA 2006 Classification)

1. Valve orifice 10 mmHg
3. Pulmonary artery systolic pressure > 50 mmHg

17

Cardiac Catheterisation

Assess coronary arteries

18

Management Medical

Optimise RFs: statins, antihypertensives, DM
Monitor: regular f/up with echo
Consider prophylaxis vs. rheumatic fever e.g. Pen V
AF: rate control and anticoagulate
Diuretics provide symptoms relief

19

Management surgical

1. Indicated in mod-severe MS (asympto and symptomatic)
2. Percutaneous balloon valvuloplasty
Treatment of choice
Suitability depends on valve characteristics: pliable, minimally calcified
CI if left atrial mural thrombus

3. Surgical valvotomy/commissurotomy: valve repair

4. Valve replacement if repair not possible

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