Mitral Stenosis

Introduction 

-The mitral valve has two leaflets, anterior and posterior

-Mitral stenosis is a condition where the mitral valve area is reduced, causing obstruction of blood flow from the left atrium into the left ventricle during left ventricular diastole

-MS can cause elevated left atrial pressure resulting in pulmonary hypertension, pulmonary edema, and right heart failure. 

-the most common cause of mitral valve stenosis: Rheumatic heart disease 

-Other causes include congenital, SLE, RA, myxoma 

Symptoms & signs 

-Rosy cheeks (mitral facies), Fatigue, exertional dyspnea, orthopnea, heart failure, atrial fibrillation, pulmonary hypertension, right-sided heart failure (ascites, pedal edema, weight gain), hemoptysis, hoarseness of voice (Ortner syndrome), systemic embolization 

-Accentuated first heart sound, an opening snap following the second heart sound, mid-diastolic low-pitched rumbling murmur best heard at the apex with the patient in the left lateral position 

Diagnosis 

ECG: tall peaked P waves, broad bifid P waves (P mitrale), right axis deviation,  LA abnormality, atrial fibrillation 

Echocardiography: thickened mitral valve leaflets, fish-mouth appearance of mitral valve, “hockey-stick” motion of the anterior leaflet, enlarged left atrium 

Chest x-ray: Left atrial enlargement, horizontal lines in the regions of the costophrenic angles representing interstitial edema (Kerley A and B lines) 

Treatment 

Asymptomatic: no treatment 

Symptomatic: Balloon valvuloplasty or valve replacement

Medications: diuretics, beta blockers,calcium channel blockers, anticoagulants

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