Mitral Stenosis

• What is mitral stenosis?


  Thickening & immobility of mitral leaflets -> restricts blood flow from LA to LV

  Can lead to pulmonary HTN & RHF
• Pathophys MS -> RHF


  Thickening & immobility of mitral leaflets → obstructs blood flow from LA to LV during diastole → increased LA pressure → LA enlargement & predisposes to AF

  Elevated LA pressure → pulmonary venous HTN & subsequent pulmonary arterial HTN → RV hypertrophy & dilation → progression to RHF

  In addition, reduce preload in LV → may impair CO & contribute to exercise intolerance
• What are the signs & symptoms of mitral stenosis?


  SOB

  Haemoptysis

  Malar flush

  Low pulse volume

  Mid-late diastolic murmur (best heard during expiration)

  Loud S1

  Opening snap

  AF
• What are the RFs of mitral stenosis?


  Hx of rheumatic fever

  Congenital mitral stenosis (rare)

  Calcific mitral stenosis

  IE

  SLE

  Carcinoid syndrome

  Mucopolysaccharidoses
• What are the Inx of mitral stenosis?


  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&E, LFTs, CRP)

  CXR

  Echo
• Echo is key in diagnosis & assessment of mitral stenosis severity.
• What does an ECG show in mitral stenosis?


  Signs of LA enlargement

  • bifid P wave in lead II
  • broad, negative P wave in lead V1

  Advanced stages -> AF, RV hypertrophy, signs of pulmonary HTN
• What can a CXR show in mitral stenosis?


  Cardiac enlargement -> straightening of L heart border (due LA enlargement), elevation of L main stem bronchus

  Pulmonary venous congestion

  Pulmonary oedema
• What are the DDx of mitral stenosis?


  Left atrial myxoma (echo will show clear mass lesion)

  Unexplained AF
• What are the complications of mitral stenosis?


  AF

  Pulmonary HTN

  Thromboembolism

  IE

  Haemoptysis

  Pregnancy Complications
• What is the treatment & management of mitral stenosis?


  Diuretics

  Rate control (AF)

  Anticoagulation (AF)

  Percutaneous balloon valvuloplasty

  Surgical intervention (mitral valve repair or replacement)
• What are the indications for surgery in mitral stenosis?


  Severe symptomatic mitral stenosis not amenable to valvuloplasty

  Presence of LA thrombus

  Significant mitral regurgitation