12.25.2011

Mitral stenosis symptoms and treatment

Posted on 12:18 AM by know about heart

It is reduction of surface of mitral or bicuspid valve. It is a heart valve disorder. In this disorder, the mitral valve does not open fully, restricting blood flow. It is more common in females then males. Two thirds of all patients with rheumatic mitral stenosis are women.
Clinical feature:
Symptom:
§ Breathlessness (due to pulmonary congestion)
§ Fatigue (due to low cardiac output)
§ Oedema, ascites (right heart failure)
§ Palpitation (atrial fibrillation)
§ Haemoptysis (due to pulmonary congestion, pulmonary embolism)
§ Cough (due to pulmonary congestion)
§ Chest pain (due to pulmonary hypertension)
§ Symptoms of thromboembolic complications (e.g. stroke, ischaemic limb)
Signs:
§ Pulse-irregularly irregular pulse (Atrial fibrillation)
§ Mitral facies (Malar flush)
§ JVP-Raised JVP if developed right heart failure.
 § Palpation: Tapping apex beat, palpable p2 if develops pulmonary hypertension.
§ Auscultation:
 Loud 1st heart sound, opening snap,
-Mid-diastolic murmur (there is a localized low pitched, rough, rumbling, mid diastolic murmur preceded by an opening snap with a pre-systolic accentuation without any radiation best heard by the bell of the stethoscope over the mitral area patient in left lateral position breath hold after expiration.)
 § Sins of raised pulmonary cpaillary pressure:
Crepitations, pulmonary oedema, effusions.
§ Signs of pulmonary hypertension: RV heave, loud p2.
CAUSES OF MITRAL STENOSIS:
1) Rheumatic heart disease (the commonest cause)
2)Congenital mitral stenosis
3)Calcification of valve
4)Carcinoid syndrome
5)Fabry's disease
6)Methysergide
7)Whipple's disease
8)Obstruction by large vegetation
9)Mucopolysaccharidosis.

COMPLICATION OF MITRAL STENOSIS:
1. Atrial fibrillation
2. Pulmonary oedema
3. Haemoptysis
4. Enlargement of left atrium
Investigation of mitral stenosis:
1.ECG: Relatively insensitive technique for detection of MS.
§ left atrial hypertrophy (p mitrale , bifid P-wave in lead II, >0.12 seconds)
§ Right ventricular hypertrophy (Tall R wave in V1, V2 & deeo 5 wave in V5 V6)  2.Chest x-ray:
 § Enlarged left atrium: Straightening of left heart border,  Double contour of rt heart border,  Upper lope diversion, Widening of carnia ,
§signus of pulmonary venous congestion: kerly’s Blines, Ground glass appearance.
3. Echo:
§ Thickened immobile cusps,
§ Reduced valve area
§ Reduced rate of diastolic filling of LV.
4. Doppler:
§ Pressure gradient across mitral valve
§ Pulmonary artery pressure
§ Left ventricular function.
5.Cardiac catheterization
Treatment:
 1. Medical treatment (Remember=A D D A)
§ Anti-coagulants: Aspirin 75 mg daily to reduce the risk of systemic embolization.
§ Ventricular rate control by Digoxin: 0.25 mg/day, beta blocker or calcium channel blocker in atrial fibnrillation.
§ Diuretics to control pulmonary congestion.
§ Prophylactic antibiotic against infective endocarditis & rheumatic fever.
2. Definitive treatment:
§ Mital ballon valvual plasty: treatment of choice.
§ Mitral valvoltomy-if facilities or expertise for valvulpolasty are not available. § Mitral valve replacement.
iii) Monitoring & after care: Echocardiography § ECG

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