Mitral stenosis: Difference between revisions

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==Background==
==Background==
*Most likely cause is rheumatic fever
[[File:Blausen 0648 MitralValveStenosis.png|thumb|Drawing of mitral stenosis.]]
*Chronic [[rheumatic disease]] uncommon in western world, but still very common in underdeveloped countries<ref>Lung B. Mitral stenosis still a concern in heart valve diseases. Archives of Cardiovascular Diseases
[[File:Rheumatic heart disease, gross pathology 20G0013 lores.jpg|thumb|Mitral valve stenosis from rheumatic heart disease on pathology (thickened mitral valve, thickened chordae tendineae, hypertrophied left ventricular myocardium).]]
*Most common cause (~85%) is rheumatic fever  
*Chronic [[rheumatic disease]] uncommon in western world, but still very common in developing countries<ref>Lung B. Mitral stenosis still a concern in heart valve diseases. Archives of Cardiovascular Diseases
Volume 101, Issue 10, October 2008, Pages 597–599.</ref>
Volume 101, Issue 10, October 2008, Pages 597–599.</ref>
**USA, 0.25 per 1000 people
**USA - 0.25 per 1000 people
**India and Pakistan, 5 per 1000 people
**India and Pakistan - 5 per 1000 people
**Cambodia, 21.5 per 1000 people
**Cambodia - 21.5 per 1000 people
**Mozambique, 30.4 per 1000 people
**Mozambique - 30.4 per 1000 people
*Other etiologies:
*Other etiologies:
**Stenotic annular calcification
**Stenotic annular calcification (~12%)
**Congenital, rare
***Degenerative/age-related
***Post-infectious
**Congenital (~0.6%)
***Annulus hypoplasia
***Parachute
***Double orifice


==Clinical Features==
==Clinical Features==
[[File:Phonocardiograms from normal and abnormal heart sounds.svg|thumb|Phonocardiograms of common cardiac murmurs.]]
*Mid-diastolic [[murmur]]
*Mid-diastolic [[murmur]]
*Symptoms
*Symptoms and complications
**Exertional dyspnea
**Exertional [[dyspnea]]
**PND
**PND
**Acute [[pulmonary edema]]
**Acute [[pulmonary edema]]
**R-sided HF symptoms
**[[Tricuspid regurgitation]]
**Hemoptysis (pulmonary htn > ruptured bronchial vein)
**[[Cor pulmonale]]
**[[Hemoptysis]] ([[pulmonary hypertension]] > ruptured bronchial vein)
**[[Atrial fibrillation]]
**[[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==
{| 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&nbsp;cm<sup>2</sup>
|-
| Severe mitral stenosis
| 5–10 mmHg
| 1.0–1.5&nbsp;cm<sup>2</sup>
|-
| Very severe mitral stenosis
| > 10 mmHg
| < 1.0&nbsp;cm<sup>2</sup>
|}
*[[ECG]]
*[[ECG]]
**RAD
**RAD
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*[[CXR]]
*[[CXR]]
**Straightening of right heart border
**Straightening of right heart border
*Echo
*[[Echocardiography]]
 
==Differential Diagnosis==
{{Valvular emergencies DDX}}


==Management==
==Management==
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**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
==Complications==
 
*Systemic emboli
==Disposition==
*[[CHF]]
*[[Atrial fibrillation]]
*[[Endocarditis]]


==See Also==
==See Also==
*[[Valvular Emergencies]]
*[[Valvular Emergencies]]
*[[Heart Murmurs]]
*[[Heart Murmurs]]
==External Links==
==References==
==References==
<references/>
<references/>
[[Category:Cardiology]]
[[Category:Cardiology]]

Latest revision as of 18:01, 13 November 2024

Background

Drawing of mitral stenosis.
Mitral valve stenosis from rheumatic heart disease on pathology (thickened mitral valve, thickened chordae tendineae, hypertrophied left ventricular myocardium).
  • 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

Clinical Features

Phonocardiograms of common cardiac murmurs.

Complications

Differential Diagnosis

Valvular Emergencies

Evaluation

Severity of mitral stenosis
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
  • ECG
    • RAD
    • Biphasic P waves
    • Most common arrhythmia is AF
  • CXR
    • Straightening of right heart border
  • Echocardiography

Management

Disposition

See Also

External Links

References

  1. ↑ Lung B. Mitral stenosis still a concern in heart valve diseases. Archives of Cardiovascular Diseases Volume 101, Issue 10, October 2008, Pages 597–599.
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