Mitral stenosis: Difference between revisions
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*Mid-diastolic [[murmur]] | *Mid-diastolic [[murmur]] | ||
*Symptoms and complications | *Symptoms and complications | ||
**Exertional dyspnea | **Exertional [[dyspnea]] | ||
**PND | **PND | ||
**Acute [[pulmonary edema]] | **Acute [[pulmonary edema]] | ||
**[[Tricuspid regurgitation]] | **[[Tricuspid regurgitation]] | ||
**[[Cor pulmonale]] | **[[Cor pulmonale]] | ||
**Hemoptysis (pulmonary | **[[Hemoptysis]] ([[pulmonary hypertension]] > ruptured bronchial vein) | ||
**[[Atrial fibrillation]] | **[[Atrial fibrillation]] | ||
**Thromboembolism | **[[Thromboembolism]] | ||
**Precipitants: | **Precipitants: | ||
***[[Anemia]] | ***[[Anemia]] | ||
***Pregnancy | ***[[Pregnancy]] | ||
***Infection | ***Infection | ||
***[[A-fib]] | ***[[A-fib]] | ||
===Complications=== | |||
*Systemic emboli | |||
*[[CHF]] | |||
*[[Atrial fibrillation]] | |||
*[[Endocarditis]] | |||
==Differential Diagnosis== | |||
{{Valvular emergencies DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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*[[CXR]] | *[[CXR]] | ||
**Straightening of right heart border | **Straightening of right heart border | ||
* | *[[Echocardiography]] | ||
==Management== | ==Management== | ||
| Line 49: | Line 55: | ||
**Alleviates pulmonary congestion | **Alleviates pulmonary congestion | ||
*[[A-fib]] treatment | *[[A-fib]] treatment | ||
*Hemoptysis | *[[Hemoptysis]] | ||
**Consider transfusion / surgery consult | **Consider [[RBCs|transfusion]] / surgery consult | ||
*Endocarditis prophylaxis after replacement | *Endocarditis prophylaxis after replacement | ||
==See Also== | ==See Also== | ||
Revision as of 15:42, 25 September 2019
Background
- Most common cause (~85%) is rheumatic fever
- Chronic rheumatic disease uncommon in western world, but still very common in developing countries[1]
- USA - 0.25 per 1000 people
- India and Pakistan - 5 per 1000 people
- Cambodia - 21.5 per 1000 people
- Mozambique - 30.4 per 1000 people
- Other etiologies:
- Stenotic annular calcification (~12%)
- Degenerative/age-related
- Post-infectious
- Congenital (~0.6%)
- Annulus hypoplasia
- Parachute
- Double orifice
- Stenotic annular calcification (~12%)
Clinical Features
- Mid-diastolic murmur
- Symptoms and complications
- Exertional dyspnea
- PND
- Acute pulmonary edema
- Tricuspid regurgitation
- Cor pulmonale
- Hemoptysis (pulmonary hypertension > ruptured bronchial vein)
- Atrial fibrillation
- Thromboembolism
- Precipitants:
Complications
- Systemic emboli
- CHF
- Atrial fibrillation
- Endocarditis
Differential Diagnosis
Valvular Emergencies
Evaluation
- ECG
- RAD
- Biphasic P waves
- Most common arrhythmia is AF
- CXR
- Straightening of right heart border
- Echocardiography
Management
- Diuretics
- Alleviates pulmonary congestion
- A-fib treatment
- Hemoptysis
- Consider transfusion / surgery consult
- Endocarditis prophylaxis after replacement
See Also
References
- ↑ Lung B. Mitral stenosis still a concern in heart valve diseases. Archives of Cardiovascular Diseases Volume 101, Issue 10, October 2008, Pages 597–599.