p.3
Differential Diagnosis of Mitral Stenosis
How can significant mitral regurgitation (MR) be differentiated from mitral stenosis (MS)?
In MR, the diastolic murmur starts slightly later than in MS, and there is often clear evidence of left ventricular enlargement, while an opening snap (OS) and increased P2 are absent.
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Physical Examination Findings in Mitral Stenosis
What are Kerley B lines and when do they appear?
Kerley B lines are fine, dense, opaque, horizontal lines that appear when the resting mean left atrial pressure exceeds ~20 mmHg, resulting from distention of interlobular septae and lymphatics with edema.
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Treatment Options for Mitral Stenosis
Which medications are useful in slowing the ventricular rate in patients with atrial fibrillation (AF) and mitral stenosis?
Beta blockers, nondihydropyridine calcium channel blockers (e.g., verapamil or diltiazem), and digitalis glycosides.
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Etiology and Pathology of Mitral Stenosis
How has the incidence of mitral stenosis changed in high-income countries?
It has declined considerably due to reductions in acute rheumatic fever.
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Symptoms and Clinical Presentation of Mitral Stenosis
What complications can arise from untreated mitral stenosis?
Pulmonary infections, recurrent pulmonary emboli, and hemoptysis.
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Mitral Valve Surgery and Outcomes
What is the indication for mitral commissurotomy?
Symptomatic patients with isolated severe mitral stenosis and an effective orifice area <1 cm²/m² body surface area.
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Treatment Options for Mitral Stenosis
What is the significance of penicillin prophylaxis in mitral stenosis?
Penicillin prophylaxis is used for secondary prevention of rheumatic fever in patients with rheumatic mitral stenosis.
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Symptoms and Clinical Presentation of Mitral Stenosis
What symptoms may develop in patients with mitral stenosis as the disease progresses?
Dyspnea, cough, orthopnea, paroxysmal nocturnal dyspnea, and limitations in daily activities.
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Treatment Options for Mitral Stenosis
What is the purpose of infective endocarditis prophylaxis in patients with rheumatic mitral stenosis (MS)?
To prevent complications from infection in high-risk patients, including those with a history of endocarditis.
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Pathophysiology of Mitral Stenosis
What is the hemodynamic hallmark of mitral stenosis?
An abnormally elevated left atrioventricular pressure gradient.
p.1
Pathophysiology of Mitral Stenosis
What happens to pulmonary compliance in mitral stenosis?
It is reduced due to elevated pulmonary venous and arterial wedge pressures.
p.2
Physical Examination Findings in Mitral Stenosis
What does the opening snap (OS) of the mitral valve indicate?
It is associated with mitral stenosis and follows the sound of aortic valve closure.
p.4
Symptoms and Clinical Presentation of Mitral Stenosis
What dietary recommendation is often made for symptomatic patients with mitral stenosis?
Restriction of sodium intake.
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Diagnostic Approaches for Mitral Stenosis
What is the role of cardiac catheterization in mitral stenosis?
Cardiac catheterization can help resolve discrepancies between clinical and noninvasive findings and assess associated lesions.
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Treatment Options for Mitral Stenosis
What is the recommended procedure for pregnant patients with mitral stenosis (MS) experiencing pulmonary congestion?
Commissurotomy should be carried out if pulmonary congestion occurs despite intensive medical treatment.
p.2
Pathophysiology of Mitral Stenosis
What are the main causes of pulmonary hypertension in mitral stenosis?
1) Passive backward transmission of elevated left atrial (LA) pressure, 2) pulmonary arteriolar constriction, 3) interstitial edema in small pulmonary vessels, 4) organic obliterative changes in the pulmonary vascular bed.
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Physical Examination Findings in Mitral Stenosis
What is the significance of a diastolic murmur in mitral stenosis?
Its duration correlates with the severity of the stenosis.
p.4
Treatment Options for Mitral Stenosis
What is indicated for patients with recent onset AF and non-severe mitral stenosis?
Reversion to sinus rhythm pharmacologically or by electrical countershock.
p.4
Mitral Valve Surgery and Outcomes
What is the advantage of percutaneous mitral balloon commissurotomy (PMBC) compared to surgical commissurotomy?
PMBC has less morbidity and a lower periprocedural mortality rate.
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Differential Diagnosis of Mitral Stenosis
What is the significance of the Austin Flint murmur?
The Austin Flint murmur, associated with severe aortic regurgitation (AR), may be mistaken for MS but can be differentiated as it is not intensified in pre-systole and becomes softer with vasodilators.
p.2
Pathophysiology of Mitral Stenosis
What is the significance of a mitral valve area less than 1 cm² in patients with severe mitral stenosis (MS)?
It indicates subnormal cardiac output (CO) at rest and potential decline during activity.
p.3
Differential Diagnosis of Mitral Stenosis
What auscultatory findings suggest significant mitral regurgitation?
An apical pansystolic murmur of at least grade III/VI intensity and an S3 suggest significant MR.
p.5
Mitral Valve Surgery and Outcomes
What is the average perioperative mortality rate for mitral valve replacement (MVR) in patients over 65 with significant comorbidities?
May be twice as high compared to younger patients.
p.5
Treatment Options for Mitral Stenosis
What is the significance of mitral valve area in determining the need for mitral valve replacement?
MVR is indicated if the mitral valve area is ≤1.5 cm² and the patient is symptomatic.
p.2
Diagnostic Approaches for Mitral Stenosis
What does an ECG typically show in patients with mitral stenosis?
Tall and peaked P waves suggestive of left atrial enlargement.
p.1
Etiology and Pathology of Mitral Stenosis
What pathological changes occur in rheumatic mitral stenosis?
Diffuse thickening of valve leaflets, fusion of mitral commissures, and calcification.
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Etiology and Pathology of Mitral Stenosis
What are some major causes of acute mitral regurgitation (MR)?
Infective endocarditis, papillary muscle rupture post-myocardial infarction, chordal rupture, and blunt trauma.
p.2
Diagnostic Approaches for Mitral Stenosis
What role does echocardiography play in the assessment of mitral stenosis?
It provides critical information on mitral inflow velocity, transvalvular gradients, and the presence of associated valvular lesions.
p.5
Etiology and Pathology of Mitral Stenosis
What are the two types of mitral regurgitation (MR)?
Primary (degenerative) MR and secondary (functional) MR.
p.1
Pathophysiology of Mitral Stenosis
How does tachycardia affect mitral stenosis?
It augments the transvalvular pressure gradient and elevates left atrial pressure.
p.3
Differential Diagnosis of Mitral Stenosis
What are the clinical features of an atrial septal defect (ASD) that can be confused with mitral stenosis?
Both conditions may show RV enlargement and accentuated pulmonary vascularity, but ASD lacks LA enlargement and Kerley B lines.
p.3
Treatment Options for Mitral Stenosis
What is the recommended treatment for severe rheumatic mitral stenosis?
Treatment options include percutaneous mitral balloon commissurotomy (PMBC) or mitral valve surgery, depending on the patient's condition.
p.4
Diagnostic Approaches for Mitral Stenosis
What factors are assessed using an 'echo score' for patients undergoing PMBC?
Degree of leaflet thickening, calcification, mobility, and extent of subvalvular thickening.
p.4
Mitral Valve Surgery and Outcomes
What defines successful commissurotomy?
A 50% reduction in the mean mitral valve gradient and a doubling of the mitral valve area.
p.2
Physical Examination Findings in Mitral Stenosis
What physical examination findings are associated with severe mitral stenosis?
Malar flush, prominent 'a' waves in jugular venous pulse, diastolic thrill at the cardiac apex, and a diastolic rumbling murmur.
p.5
Treatment Options for Mitral Stenosis
What is the role of commissurotomy in asymptomatic patients with mild or moderate stenosis?
It is not recommended unless there is recurrent systemic embolization or severe pulmonary hypertension.
p.5
Mitral Valve Surgery and Outcomes
What factors can affect the long-term prognosis of patients undergoing mitral valve surgery?
Age, left ventricular function, presence of coronary artery disease, and associated comorbidities.
