Mitral stenosis general approach to mitral stenosis: Difference between revisions

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{{Mitral stenosis}}


{{CMG}} {{AE}} {{RT}}
==Overview==
[[Mitral stenosis]] is a valvular disease characterized by a narrowing in the heart valve between the two left chambers of the heart ([[left atrium]] and [[left ventricle]]).
==Pathophysiology==
* Commisural fusion is the hallmark anatomic finding in mitral stenosis.
* The narrowing in the [[mitral valve]]  causes build up of pressures in the left atrium, and eventually in the pulmonary bed.
* The build up of pressures in the pulmonary bed leads to [[pulmonary hypertension]] which results in [[right heart failure]].
* The left ventricle is unaffected in pure mitral stenosis.
==Causes==
The cause of [[mitral stenosis]] is almost always [[rheumatic heart disease]].
==Differentiating Mitral stenosis from other Diseases==
Mitral stenosis should be differentiated from:
* [[Cor triatriatum]]
* [[Atrial myxoma]]
* Pulmonary vein obstruction
==Natural History and Complications==
===Natural History===
Mitral stenosis is intermittently progressive and has a prolonged clinical course before becoming severe.
===Complications===
Complications occur in the late stages of mitral stenosis. They include:
* [[Atrial fibrillation]]
* [[Pulmonary hypertension]]
* [[Right heart failure]]
* [[Stroke]] - due to thrombus formation in the [[left atrium]]
==Diagnosis==
===Symptoms===
Symptoms of mitral stenosis occur late in the course of the disease as the disease progresses slowly over decades. Common symptoms include:
* [[Dyspnea]]
* [[Paroxysmal nocturnal dyspnea]]
* [[Orthopnea]]
* [[Hemoptysis]]
* [[Palpitations]]
* [[Emboli]]
===Physical Examination===
* A high pitched additional sound called opening snap (OS) may be heard after the A<sub>2</sub> component of S<sub>2</sub> and it signifies the forceful opening of the mitral valve.
* The S<sub>2</sub> - OS interval determines the severity of mitral stenosis.
** Mild: >110 msec
** Moderate: 70-110 msec
** Severe: <70 msec
The closer the gap between S<sub>2</sub> and OS the severe the stenosis is.
===Imaging===
====Echocardiography====
* ECHO is the gold standard for diagnosis and quantification of [[mitral stenosis]].  It is a better diagnostic tool than cardiac catheterization.
* To define the anatomy of the stenotic lesion a 2D echocardiography is used and to define the hemodynamics of blood flow through the stenotic valve a Doppler ECHO is preferred.
** Doppler is the gold standard for quantifying the transmitral pressure gradient.
==Treatment==
* General principles in the management of mitral stenosis include:
** [[Anticoagulation]] - if [[atrial fibrillation]] is present
** For class I and II symptoms observing is the preferred treatment.
** Replacement of mitral valve - if class III and IV symptoms.
===Percutaneous mitral balloon valvotomy===
====Indications====
* Class II, III and IV symptoms
* Asymptomatic patients with:
** Pulmonary artery pressure >60mm Hg
** New onset [[atrial fibrillation]]
====Contraindications====
* Mitral regurgitation +2
* Left atrium [[thrombus]]
* Severe calcifications of the mitral valve
Results of the procedure are excellent with pliable valves, fused commisures and with no calcium deposits on the valve.
==References==
{{Reflist|2}}
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]
[[Category:Overview complete]]
[[Category:For review]]
[[Category:Template complete]]
{{WH}}
{{WS}}

Latest revision as of 18:13, 17 January 2013