Cardiovascular System > Valvular Disease >
Mitral Stenosis
“Narrowing of the mitral valve that impedes flow of blood from the Left Atrium (LA) into the Left Ventricle (LV)”
Risk Factors
- Rheumatic Fever
- Prosthetic Valve
- Systemic lupus erythematosus
Aetiology
Valve doesn’t open fully → obstruction to filling during diastole → diastolic murmur
Pathophysiology
- ↑ LA pressure → LA hypertrophy → pulmonary congestion & AF
- Impaired filling of LV → decreased LV volume & pressure → decreased SV
Clinical Presentation
- Symptoms
- Gradual onset
- Exertional dyspnoea
- AF – palpitations+ emboli
- CHF symptoms
- Signs
- Rumbling mid-diastolic murmur at apex à Heard on left 5th intercostal space, midclavicular line & radiates to axilla – preceded by early diastolic opening snap
- Malar flush
- AF – often
- Signs of CCF – JVP, oedema
- Left parasternal heave
- Tapping apex beat
Investigations
- Bloods:
- FBC, U+E, LFTs, glucose, lipids
- Imaging:
- Chest X-Ray – LA enlargement pulmonary oedema, mitral valve calcification
- Echocardiogram – thickened rheumatic valve, doppler shows the slower velocity of blood
- Special:
- ECG – Atrial fibrillation
Management
- Conservative: n/a
- Medical:
- Statins
- Anti-hypertensives
- Diuretics
- Digoxin
- Warfarin
- Surgical:
- Percutaneous balloon valvuloplasty
- Mitral valvotomy
- Mitral valve replacement
Complications
- Pulmonary hypertension
- Emboli – TIA, CVA, PVD, ischaemic colitis
- Dysphagia (oesophageal compression)
- Bronchial obstruction