Mitral stenosis is a narrowing of the mitral valve orifice. Fusion of the leaflet commissures reduces the orifice area. Usually occurs as a consequence of rheumatic fever.
Causes decreased filling of the left ventricle, while simultaneously increasing left atrial pressure, producing the syndrome of heart failure.
As disease progresses, pulmonary hypertension and right heart failure occur.
Mild disease can be treated symptomatically with diuretics. Moderate to severe disease requires mechanical correction of the valve obstruction by valvotomy, valve repair, or valve replacement.
Mitral stenosis is a narrowing of the mitral valve orifice, usually caused by rheumatic valvulitis producing fusion of the valve commissures and thickening of the valve leaflets.
History and exam
Key diagnostic factors
- presence of risk factors
- history of rheumatic fever
- opening snap on auscultation
- diastolic murmur
- loud P2
- neck vein distension
- paroxysmal nocturnal dyspnoea
- peripheral oedema
Other diagnostic factors
- 40 to 50 years old
- loud first heart sound (S1)
- irregularly irregular pulse
- flushed cheeks
- streptococcal infection
- female sex
- ergot medications
- serotonergic medications
- systemic lupus erythematosus (SLE)
- bronchial carcinoid syndrome
1st investigations to order
- trans-thoracic echocardiography
Investigations to consider
- trans-oesophageal echocardiography
- cardiac catheterisation
- dynamic exercise testing
- Left atrial myxoma
- Unexplained atrial fibrillation
- 2021 ESC/EACTS guidelines for the management of valvular heart disease
- 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines
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