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