Difference between revisions of "Mitral stenosis"

(Background)
 
Line 19: Line 19:
 
*Mid-diastolic [[murmur]]
 
*Mid-diastolic [[murmur]]
 
*Symptoms and complications
 
*Symptoms and complications
**Exertional dyspnea
+
**Exertional [[dyspnea]]
 
**PND
 
**PND
 
**Acute [[pulmonary edema]]
 
**Acute [[pulmonary edema]]
 
**[[Tricuspid regurgitation]]
 
**[[Tricuspid regurgitation]]
 
**[[Cor pulmonale]]
 
**[[Cor pulmonale]]
**Hemoptysis (pulmonary htn > ruptured bronchial vein)
+
**[[Hemoptysis]] ([[pulmonary hypertension]] > ruptured bronchial vein)
 
**[[Atrial fibrillation]]
 
**[[Atrial fibrillation]]
**Thromboembolism
+
**[[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.