Mitral stenosis: Difference between revisions

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==Background==
==Background==
*Most likely cause is rheumatic fever, ~85%
*Most common cause (~85%) is rheumatic fever  
*Chronic [[rheumatic disease]] uncommon in western world, but still very common in underdeveloped 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
Volume 101, Issue 10, October 2008, Pages 597–599.</ref>
Volume 101, Issue 10, October 2008, Pages 597–599.</ref>
**USA, 0.25 per 1000 people
**USA - 0.25 per 1000 people
**India and Pakistan, 5 per 1000 people
**India and Pakistan - 5 per 1000 people
**Cambodia, 21.5 per 1000 people
**Cambodia - 21.5 per 1000 people
**Mozambique, 30.4 per 1000 people
**Mozambique - 30.4 per 1000 people
*Other etiologies:
*Other etiologies:
**Stenotic annular calcification, ~12% (degenerative, aging, post-infection)
**Stenotic annular calcification (~12%)
**Congenital, rare at ~0.6%
***Degenerative/age-related
***Post-infectious
**Congenital (~0.6%)
***Annulus hypoplasia
***Parachute
***Double orifice


==Clinical Features==
==Clinical Features==
*Mid-diastolic [[murmur]]
*Mid-diastolic [[murmur]]
*Symptoms
*Symptoms and complications
**Exertional dyspnea
**Exertional [[dyspnea]]
**PND
**PND
**Acute [[pulmonary edema]]
**Acute [[pulmonary edema]]
**R-sided HF symptoms
**[[Tricuspid regurgitation]]
**Hemoptysis (pulmonary htn > ruptured bronchial vein)
**[[Cor pulmonale]]
**[[Hemoptysis]] ([[pulmonary hypertension]] > ruptured bronchial vein)
**[[Atrial fibrillation]]
**[[Thromboembolism]]
**Precipitants:
**Precipitants:
***[[Anemia]]
***[[Anemia]]
***Pregnancy
***[[Pregnancy]]
***Infection
***Infection
***[[A-fib]]
***[[A-fib]]
===Complications===
*Systemic emboli
*[[CHF]]
*[[Atrial fibrillation]]
*[[Endocarditis]]
==Differential Diagnosis==
{{Valvular emergencies DDX}}


==Evaluation==
==Evaluation==
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*[[CXR]]
*[[CXR]]
**Straightening of right heart border
**Straightening of right heart border
*Echo
*[[Echocardiography]]
 
==Differential Diagnosis==
{{Valvular emergencies DDX}}


==Management==
==Management==
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**Alleviates pulmonary congestion
**Alleviates pulmonary congestion
*[[A-fib]] treatment
*[[A-fib]] treatment
*Hemoptysis
*[[Hemoptysis]]
**Consider transfusion / surgery consult
**Consider [[RBCs|transfusion]] / surgery consult
*Endocarditis prophylaxis after replacement
*Endocarditis prophylaxis after replacement
==Complications==
*Systemic emboli
*[[CHF]]
*[[Atrial fibrillation]]
*[[Endocarditis]]


==See Also==
==See Also==

Latest revision as of 15:42, 25 September 2019

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

Clinical Features

Complications

Differential Diagnosis

Valvular Emergencies

Evaluation

  • ECG
    • RAD
    • Biphasic P waves
    • Most common arrhythmia is AF
  • CXR
    • Straightening of right heart border
  • Echocardiography

Management

See Also

References

  1. Lung B. Mitral stenosis still a concern in heart valve diseases. Archives of Cardiovascular Diseases Volume 101, Issue 10, October 2008, Pages 597–599.