“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

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