Condition- Mitral Stenosis

Question 1

What is mitral stenosis

Answer 1

Mitral valve narrowing causing obstruction to blood flow from the left atrium to the left ventricle

Question 2

Why is the incidence of mitral stenosis falling?

Answer 2

Because of the decline in the incidence of rheumatic fever

Question 3

What is the main cause of mitral stenosis? List some other rarer causes too

Answer 3

RHEUMATIC HEART DISEASE

• Congenital
• Mucopolysaccharidoses
• prosthetic valve
• SLE
• Rheumatoid Arthritis
• Endocarditis
• Atrial myxoma

Question 4

List some of the presenting symtpoms of mitral stenosis

Answer 4

• May be ASYMPTOMATIC
• APEX
  
  • AF
  • Palpitations/ chest pain
  • Exertional dyspnoea (+orthopnoea)
  • Xtreme tiredness= Fatigue
• Resp symtpoms: chronic bronchitis type
  
  • Cough
  • Haemoptysis
  • Hoarseness caused by compression of left laryngeal by enlarged LA

Question 5

List some of the signs of Mitral stenosis on auscultation

Answer 5

• Loud S1 with opening snap (stiffened valves open with a snap)
• Mid-diastolic murmur- accentuated when lying left lateral on expiration
• Loud P2 (sign of pulmonary hypertension)
• bibasal creps

Question 6

List some signs of mitral stenosis on physical examination

Answer 6

• Peripheral cyanosis
• Malar flush (decreased CO)
• AF pulse
• Low volume pulse
• Raised JVP + ascites + bibasal creps
• Apex beat UNdisplaced + tapping
• Parasternal heave (right ventricular hypertrophy 2^o to pulmonary hypertension)
• Mid-diastolic murmur heard best in left lateral
• Loud S1 with opening snap

Question 7

Which investigation can be used to definitively diagnose Mitral Stenosis?

Answer 7

Echocardiogram = hockey-stick shaped mitral deformity

Oftem to transoesophageal= better picture

Question 8

What might you see on a CXR of a patient with Mitral Stenosis

Answer 8

• double right heart border= enlarged left atrium
• cardiac enlargement
• pulmonary oedema- Kerley B lines
• prominant pulmonary artery
• Mitral valve calcification

Question 9

What might you see on an ECG of a patient with Mitral Stenosis?

Answer 9

• May be Normal
• May see p mitrale (left atrial hypertrophy)
• May see AF
• Evidence of left ventricular hypertrophy if severe pulmonary hypertension