Mitral Stenosis
Not yet clinically reviewed
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- Characterized by narrowing of mitral valve orifice resulting in left atrial hypertrophy & dilation.
- Normal mitral valve surface area is 4-6cm.
- It is most often caused by rheumatic heart disease.
- Intervention indicated for symptoms, atrial fibrillation, or evidence of pulmonary hypertension. Most symptomatic patients have a mitral valve area of less than 1.5 cm
Clinical features
- Mitral stenosis often presents in young adult patient with dyspnea, palpitations, fatigue (due low cardiac output), dysphagia (due to left atrium pressing on the esophagus), hemoptysis (from pulmonary edema and pulmonary HTN) and embolic events e.g., stroke. Symptoms often precipitated by onset of atrial fibrillation or pregnancy.
On examination
Apex beat is localized and tapping. First heart sounds are loud and there is mid - diastolic murmur. just after an opening snap (best heard in left - lateral decubitus position during expiration using bell of stethoscope).
Investigations
- ECG may show Atrial fibrillation; bifid P - waves i.e., P - mitrale (due to left atrial hypertrophy).
- CXR shows mitrilization (straightening of left heart border due to atrial hypertrophy) and signs of pulmonary venous congestion.
- Echocardiography show thickened immobile cusps; reduced valve area and enlarged left atrium.
Management
- Diuretics and sodium restriction
- Warfarin for AF to an INR of 2-3 and digoxin, beta blocker or Diltiazem / verapamil for rate control of atrial fibrillation.
- Definitive treatment for mitral stenosis is ballon valvuloplasty. If it fails or cannot be done then valve replacement is recommended
- Endocarditis prophylaxis not recommended