Mitral Stenosis

Mitral Stenosis

·        Causes: rheumatic heart disease, infection (less common than aortic) ® fusion of the leaflets

·        Symptoms: dyspnoea, PND, haemoptysis, arrhythmia (® palpitations), RH signs if pulmonary hypertension

·        Signs:

o  Loud S1, opening snap after S2 (loudest at apex)

o  Long, loud diastolic murmur accentuated just before S1 (atrial systole – not if AF). Loudest with bell at apex and left lateral side

o  Pulmonary oedema is worse than in other causes (eg mitral regurgitation)

o  If pulmonary hypertension then low cardiac output failure® thin patient, peripheral cyanosis, cool extremities, small pulse volume. Dilated veins and cyanosis of cheeks = mitral facies

·        Leads to:

o  LA enlargement:

§  ® pulmonary hypertension (> 7.5 mmHg/L/min) and pulmonary oedema

§  ® AF

o  Bronchitis

·        Investigations:

o  ECG: broad P wave, RV hypertrophy (NB – LV enlargement is not typical – key differential with mitral regurgitation)

o  X-ray: LA enlargement, RH enlargement

o  Echo: good at imaging the mitral valve

·        Differential: Left atrial myxoma (much less common)

·        Treatment:

o  Prophylaxis for RF (till 20) and infective endocarditis (eg dental work)

o  Surgery: valvotomy, balloon valvuloplasty, replacement