Mitral stenosis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Blausen 0648 MitralValveStenosis.png|thumb|Drawing of mitral stenosis.]] | [[File:Blausen 0648 MitralValveStenosis.png|thumb|Drawing of mitral stenosis.]] | ||
[[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 | *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 | *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 | ||
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==Evaluation== | ==Evaluation== | ||
{| class="wikitable" style="float:right;clear:right; margin-left:1em" | {| class="wikitable" style="float:right;clear:right; margin-left:1em" | ||
|+ Severity of mitral stenosis | |+ Severity of mitral stenosis | ||
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| < 1.0 cm<sup>2</sup> | | < 1.0 cm<sup>2</sup> | ||
|} | |} | ||
*[[ECG]] | |||
**RAD | |||
**Biphasic P waves | |||
**Most common arrhythmia is AF | |||
*[[CXR]] | |||
**Straightening of right heart border | |||
*[[Echocardiography]] | |||
==Management== | ==Management== | ||
| Line 79: | Line 80: | ||
**Consider [[RBCs|transfusion]] / surgery consult | **Consider [[RBCs|transfusion]] / surgery consult | ||
*Endocarditis prophylaxis after replacement | *Endocarditis prophylaxis after replacement | ||
==Disposition== | |||
==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
- 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
| 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
- Diuretics
- Alleviates pulmonary congestion
- A-fib treatment
- Hemoptysis
- Consider transfusion / surgery consult
- Endocarditis prophylaxis after replacement
Disposition
See Also
External Links
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.