Mitral stenosis

Question 1

What are the causes of mitral stenosis?

Answer 1

Rheumatic heart disease.
Calcification of valve.
Rheumatoid arthritis.
Ankylosing spondylitis.
Systemic lupus erythematosus (SLE).
Malignant carcinoid.
‘Really Cold Rhinos All Shiver Madly’

Question 2

What are the symptoms of mitral stenosis?

Answer 2

Dyspnoea.
Palpitations if in atrial fibrillation.
Heart failure.
Haemoptysis.

Question 3

What are the signs of mitral stenosis?

Answer 3

Malar flush.
Tapping apex beat.
Hoarse voice (Ortner’s syndrome).
Irregularly irregular pulse if in AF.

Question 4

Describe the murmur in mitral stenosis.

Answer 4

Low pitch mid-diastolic murmur with opening snap.

Question 5

What investigations should be performed if mitral stenosis is suspected?

Answer 5

ECG: atrial fibrillation, bifid P waves.
CXR: pulmonary oedema and enlarged left atrium may be seen.
ECHO: confirms diagnosis, allows severity and valve area to be assessed.

Question 6

What is the conservative treatment of mitral stenosis?

Answer 6

Manage cardiovascular risk factors, e.g. smoking cessation.

Question 7

What is the medical treatment of mitral stenosis?

Answer 7

Manage AF and heart failure by following NICE guidelines.

Question 8

What is the surgical treatment of mitral stenosis?

Answer 8

Valve replacement is the treatment of choice.

Question 9

What are the complications of mitral stenosis?

Answer 9

AF
Heart failure
Infective endocarditis