Valve Disease Mitral Stenosis

Pathology:                    

Mitral Valve area < 2 cm²causing increased left Atrial pressure. High pressure causes pulmonaryhypertension and symptoms of right-sided heart failure.

Aetiology:                    

More common in female,

Rheumaticheart disease (most common), endocarditis, SLE

Symptoms:                  

Dyspnoea, fatigue, orthopnoea,paroxysmal nocturnal dyspnoea, palpitations

Signs:                              

Loud S1, low-pitchedrumbling mid-diastolic murmur loudest at apex in left lateral position, malarflush, AF, pulmonary oedema, raised JVP, may develop pulmonary regurgitationdue to pulmonary HTN leading to early-diastolic Graham-Steele murmur

Investigations:          

ECG: Left Atrial Enlargement (Pmitrale), Right ventricular hypertrophy.Right

axis deviation

                                          Chest X-Ray: Left Atrial Enlargement,pulmonary congestion, Mitral Valve

calcification

Echo: Gold standard – assesses for valvular andleaflet abnormalities

Coronary angiography: concurrent CAD in patients if age> 45  

Treatment:                  

Medical: Treat AF if present with rate/rhythmcontrol and anticoagulation.

Treat right heart failure using diuretics andbeta-blockers to increase  

filling time

Surgical: Mitral valve replacement or balloonvalvotomy

Complications:          

Right-sided heart failure, AF, Stroke,Infective endocarditis, Tricuspid

regurgitation

Prognosis:                  

‍Surgery has a goodsuccess rate.

‍

                                   Bifid P-Wave (P-Mitrale)

Figure 1.15 P-Mitrale