mitral stenosis

Question 1

what does mitral valve consist of

Answer 1

• fibrous annulus
• anterior and posterior leaflets
• chordae tendineae
• papillary muscle

Question 2

most common cause

Answer 2

rheumatic diseases

Question 3

what is rheumatic fever due to

Answer 3

infection with group B haemolytic streptococcus

Question 4

who is more likely to get it men or women

Answer 4

women

Question 5

what does inflammation lead to

Answer 5

commissural fusion and a reduction in mitral valve orifice area

Question 6

what happens to the condition over many years

Answer 6

• valve thickening
• cusp fusion
• calcium deposition
• narrowed valve orifice
• immobility of the valve cusp

Question 7

other causes

Answer 7

• congenital mitral stenosis
• lutembacher syndrome
• clarification
• carcinoid tumours metastasising to lung

Question 8

what does the heart do to counteract reduced valve area

Answer 8

left atrial pressure increases

• left atrial hypertrophy
• dilatation occur

Question 9

what does pulmonary hypertension lead to

Answer 9

right ventricular hypertrophy, dilatation and failure

Question 10

symptoms

Answer 10

• SOB
• cough (blood tinged)
• right heart failure
• weakness
• fatigue
• AF
• palpitation

Question 11

signs

Answer 11

• AF
• heaving apex
• loud S1
• tapping apex
• mid-diastolic murmur
• malar flush

Question 12

what murmur is it

Answer 12

mid-diastolic

Question 13

what is JVP like

Answer 13

a wave

Question 14

what is apex like

Answer 14

tapping

Question 15

what is heard on auscultation

Answer 15

loud S1

Question 16

when is murmur best heard

Answer 16

with patient lying on their left side

Question 17

what does addition of pulmonary hypertension implies

Answer 17

it is severe

Question 18

what is done for diagnosis

Answer 18

• CXR
• ECG
• echo

Question 19

what is seen on CXR

Answer 19

• left atrial enlargement

- calcified mitral valve

Question 20

what is seen on ECG

Answer 20

• bifid p wave
• AF
• right ventricular hypertrophy (tall wave in V1)

Question 21

what is seen on echo

Answer 21

• determines left atrial size
• degree of thickening
• clarification

Question 22

what may need to be done to determine pulmonary artery pressure

Answer 22

cardiac catheterisation

Question 23

treatment for mild mitral stenosis

Answer 23

none

other than prompt therapy for attacks of bronchitis

Question 24

treatment when AF begins

Answer 24

beta blockers 
or 
DC cardioversion 
and 
anticoagulation

Question 25

treatment when pulmonary hypertension develop

Answer 25

surgery

Question 26

what are the 4 types of surgery

Answer 26

- balloon valvotomy - closed valvotomy - open valvotomy - mitral valve replacement

Question 27

what is balloon valvotomy

Answer 27

1. catheter in right atrium via femoral vein 2. interatrial septum then punctured 3. catheter into left atrium and across the mitral valve 4. balloon over catheter and lies across the valve and is inflated briefly

Question 28

contraindications of balloon valvotomy

Answer 28

- heavy calcification - mitral regurgitation - thrombus of left atrium

Question 29

what's done for non-calcified mitral valves

Answer 29

closed valvotomy

Question 30

what happens in closed valvotomy

Answer 30

fused cusps are forced apart by a dilator introduced through the apex of the left ventricle guided into position by surgeons finger lasts for about 10 years

Question 31

when is valve replacement necessary

Answer 31

- mitral regurgitation also present - badly disease or calcified stenotic valve that cannot be opened - severe mitral stenosis and thrombus of left atrium

Question 32

what is given to prevent thrombus formation

Answer 32

anticoagulant