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Mitral Stenosis
Causes
- Rheumatic fever
- rheumatic mitral stenosis much commoner in women
- Congenital
- complication of carcinoid
- methysergide
- calcific
Pathology
- fusion of commisure
- thickening
- fibrosis
- calcification
- normal left ventricle
- increased left atrium pressure
- increased pulmonary artery / right-sided pressure
History
- dyspnoea
- reduced compliance
- reduced vital capacity
- fatigue
- haemoptysis
- sudden haemorrhage
- bloody sputum
- pink / frothy - pulmonary oedema
- pulmonary infarct
- thromboembolism
- chest pain
- subacute bacterial endocarditis
- right-sided heart failure
- hoarseness of voice (ortners)
Examination
- Hands
- pulse
- Blood Pressure
- low, pulse pressure normal
- Neck
- JVP
- &uarr
- prominent V waves / prominent A wave
- Face
- mitral facies
- malar flush
- Praecordium
- Inspect
- Palpate
- undisplaced tapping apex beat
- +/- parasternal heave
- Auscultation
- loud S1 (soft later)
- opening snap
- mid-diastolic murmur
- low pitched, rumbling
- duration reflects severity
- tricuspid regurgitation murmur
- diastolic murmur of pulmonary regurgitation
- pulmonary oedema
- ankle oedema
Prognosis
- asymptomatic progress to symptoms (16.7 years on average)
- symptomatic
- mild to sever disability in 7.9 years
Treatment
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