Mitral stenosis (MS) is characterized by obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve apparatus.
Causes
- Rheumatic fever
- Calcification/degeneration of mitral valve
- Congenital mitral stenosis
Clinical features
- Malar flush (mitral facies)
- Atrial fibrillation (irregularly irregular pulse)
- Cardiac examination
- Tapping apex beat
- Diastolic thrill in mitral area
- Auscultation
- Loud first heart sound
- Opening snap
- Mid-diastolic murmur in mitral area (low pitched, rumbling)
- Signs of pulmonary hypertension
- Loud P2
- Right ventricular heave
- Signs of raised pulmonary capillary pressure
- Pulmonary crepts
- Signs of right heart failure
- Raised JVP
- Tender hepatomegaly
- Bilateral pitting pedal edema
- Ascites and pleural effusion in severe cases
Pathophysiology
Investigations
ECG may reveal the evidence of left atrial (LA) enlargement, right ventricular (RV) hypertrophy and atrial fibrillation
Treatment
MEDICAL
- Restriction of physical activity.
- Sodium restriction and diuretics are used in heart failure.
- Digoxin is given to control ventricular rate in patients with AF.
- Beta blocker and calcium antagonists (verapamil, diltiazem) can also be used.
- Oral anticoagulant (warfarin)
- Prophylaxis should be given to all patients to prevent rheumatic fever
- Prophylaxis for infective endocarditis
SURGICAL
- Mitral valvotomy
- Mitral valve replacement