Mitral stenosis: Difference between revisions
| Line 52: | Line 52: | ||
**Straightening of right heart border | **Straightening of right heart border | ||
*[[Echocardiography]] | *[[Echocardiography]] | ||
{| class="wikitable" style="float:right;clear:right; margin-left:1em" | |||
|+ Severity of mitral stenosis | |||
|- | |||
! Degree of mitral stenosis | |||
! Mean gradient | |||
! Mitral valve area | |||
|- | |||
| Progressive mitral stenosis | |||
| <5 mmHg | |||
| >1.5 cm<sup>2</sup> | |||
|- | |||
| Severe mitral stenosis | |||
| 5–10 mmHg | |||
| 1.0–1.5 cm<sup>2</sup> | |||
|- | |||
| Very severe mitral stenosis | |||
| > 10 mmHg | |||
| < 1.0 cm<sup>2</sup> | |||
|} | |||
==Management== | ==Management== | ||
Revision as of 17:56, 13 November 2024
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
| Degree of mitral stenosis | Mean gradient | Mitral valve area |
|---|---|---|
| Progressive mitral stenosis | <5 mmHg | >1.5 cm2 |
| Severe mitral stenosis | 5–10 mmHg | 1.0–1.5 cm2 |
| Very severe mitral stenosis | > 10 mmHg | < 1.0 cm2 |
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.