Mitral Stenosis
Mitral Stenosis
Short Questions & Answers on Mitral Stenosis
What is mitral stenosis?
Narrowing of the mitral valve orifice, obstructing blood flow from LA to LV.
Most common cause?
Rheumatic heart disease.
Normal mitral valve area (MVA)?
4–6 cm².
At what valve area do symptoms appear?
Usually when MVA < 2 cm².
Classical murmur?
Mid-diastolic murmur with opening snap, best heard at apex.
Common clinical features?
Dyspnea, orthopnea, hemoptysis, palpitations, fatigue.
Most common symptom?
Exertional dyspnea.
What is Ortner’s syndrome?
Hoarseness due to recurrent laryngeal nerve compression by enlarged LA.
Complications?
Atrial fibrillation, systemic embolism, pulmonary hypertension, right heart failure, infective endocarditis.
Most common complication?
Atrial fibrillation.
ECG findings?
Left atrial enlargement (P mitrale), AF, right ventricular hypertrophy (in pulmonary HTN).
X-ray findings?
Straightening of left heart border, double shadow (enlarged LA), pulmonary venous congestion, Kerley B lines.
Echo findings?
Thickened, doming mitral leaflets, restricted opening, LA enlargement, MVA measurement.
Most useful investigation?
Echocardiography.
Treatment options?
Medical: diuretics, rate control, anticoagulants.
Interventional: balloon mitral valvotomy.
Surgical: open or closed commissurotomy, valve replacement.
Indications for balloon mitral valvotomy?
Symptomatic severe MS (MVA ≤ 1.5 cm²) with pliable valve, no LA thrombus, no significant MR.
Contraindications for valvotomy?
LA thrombus, significant MR, heavily calcified/rigid valve.
Surgical options?
Open/closed commissurotomy, mitral valve replacement.
Severity classification (MVA & mean gradient):
Mild: MVA > 1.5 cm², gradient < 5 mmHg.
Moderate: MVA 1.0–1.5 cm², gradient 5–10 mmHg.
Severe: MVA < 1.0 cm², gradient > 10 mmHg.
Why AF is common?
Due to chronic LA dilatation and fibrosis from pressure overload.
| Topic – Mitral Stenosis | Key Points |
|---|---|
| Definition | Narrowing of mitral valve → obstruction of LA → LV blood flow |
| Most common cause | Rheumatic heart disease |
| Normal valve area | 4–6 cm² |
| Symptoms appear when | MVA < 2 cm² |
| Most common symptom | Exertional dyspnea |
| Other symptoms | Orthopnea, PND, hemoptysis, palpitations, fatigue |
| Signs | Malar flush, loud S1, opening snap, mid-diastolic murmur (apex), presystolic accentuation (if in sinus rhythm) |
| Special sign | Ortner’s syndrome → hoarseness (recurrent laryngeal nerve compression by LA) |
| Complications | AF (most common), systemic embolism, pulmonary HTN, RV failure, IE |
| ECG | P mitrale (LA enlargement), AF, RVH (if severe) |
| X-ray | LA enlargement (double shadow, straight left border), pulmonary venous congestion, Kerley B lines |
| Echocardiography | Diagnostic: thickened doming leaflets, MVA measurement, LA dilatation, pressure gradient |
| Severity (MVA / Mean gradient) | Mild: >1.5 cm² / <5 mmHg Moderate: 1.0–1.5 cm² / 5–10 mmHg Severe: <1.0 cm² / >10 mmHg |
| Medical treatment | Diuretics, beta-blockers/digoxin (rate control in AF), anticoagulation (AF or embolism risk) |
| Interventional | Balloon mitral valvotomy (preferred if suitable) |
| Surgical | Commissurotomy (open/closed), Mitral valve replacement |
| BMV Indications | Symptomatic severe MS, pliable valve, no LA thrombus, no significant MR |
| BMV Contraindications | LA thrombus, moderate/severe MR, heavily calcified/rigid valve |
| Why AF common? | Due to LA dilatation & fibrosis |