Mitral stenosis

Question 1

What is the definition of mitral stenosis?

Answer 1

Definition : narrowing of mitral valve

Question 2

What is the pathophysiology of mitral stenosis?

Answer 2

1. The narrowing of the mitral valve orifice, leading to obstructed blood flow from the left atrium to the left ventricle
2. Increased left arterial pressure leads to pulmonary congestion and subsequent right sided heart failure.

Question 3

What are the causes of mitral valve stenosis?

Answer 3

1. Age-related calcification
2. Fibrosis secondary to inflammation
   * Rheumatic fever
   * SLE

Question 4

What are the complications of mitral stenosis?

Answer 4

1. Atrial Fibrillation:
   The most common complication of MS, atrial fibrillation increases the risk of thromboembolic events, such as stroke.
2. Pulmonary Hypertension:
   Elevated pulmonary artery pressure may lead to right ventricular failure and cor pulmonale.
3. Thromboembolism:
   Stasis of blood in the left atrium predisposes to thrombus formation, increasing the risk of systemic embolization.
4. Infective Endocarditis:
   Damaged mitral valve leaflets are more susceptible to infection.

5.Hemoptysis:
Rupture of bronchial veins due to elevated pulmonary venous pressure may cause haemoptysis.

P6. Pregnancy Complications:
MS may worsen during pregnancy due to increased blood volume and cardiac output, potentially leading to maternal and fetal complications.

Question 5

What are the clinical features of mitral stenosis?

Answer 5

Exertional dyspnea
Orthopnea
Paroxysmal nocturnal dyspnoea
Fatigue

Question 6

What are the clinical signs of mitral stenosis?

Answer 6

1. Mid-late diastolic murmur - best heard in expiration
2. Opening snap
3. Malar flush

Question 7

Which investigations are indicated in mitral stenosis?

Answer 7

Transthoracic echo - Gold standard for diagnosis
Assessment of mitral valve morphology and calcification of calves

ECG - R. Ventricular hypertrophy and AF

Chest X-ray - pulmonary oedema

Question 8

What is the management of mitral stenosis?

Answer 8

1. Medical Therapy:
   Diuretics alleviate pulmonary congestion and peripheral oedema, while rate control (e.g., beta-blockers) and anticoagulation (e.g., warfarin) manage atrial fibrillation.
2. Percutaneous Balloon Valvuloplasty:Indicated for symptomatic patients with severe MS
   * (valve area <1.5 cm²) and favourable valve morphology,
   - this procedure involves balloon dilation of the mitral valve to alleviate stenosis.
3. Surgical Intervention:
   Indications include severe symptomatic MS not amenable to valvuloplasty, presence of left atrial thrombus, and significant mitral regurgitation.