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Valvular Heart Disease: Mitral Stenosis

by Carlo Raj, MD
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    People always ask me "Dr. Raj, what is the difference between mitral regurg and mitral valve prolapse." Well, this topic of valvular heart disease brings us to issues of the mitral valve in general. Walk you through mitral stenosis and then have you differentiate between mitral regurgitation and mitral valve prolapse. And for learning purposes, please make sure that you distinguish and you keep separate mitral regurg and mitral valve prolapse. Trust me you will make here life so much more easier and you will be the MVP of this particular section. Let us begin. Mitral stenosis is where we are. And before we start you need to conceptualize this. I already have, but it is about me imparting that conceptualization onto you. Mitral valve stenosis, what does that mean? Difficulty with opening. In this case, the mitral valve doesn't want to open. When is the mitral valve supposed to open? During what? Diastole good. During diastole was when the mitral valve was supposed to open, but it does not. And so, therefore, what kind of valvular heart disease would you categorise this as? A diastolic murmur. So now, we have two diastolic murmurs or we will have two diastolic murmurs that we have gone through. The first one being aortic regurgitation. And with aortic regurgitation, it was the fact that the aortic valve was unable to close properly and the diastolic murmur was early, immediately after S2. In this case, well there is a little bit different actually a lot different. And if you were doing an echocardiogram and the mitral valve doesn't wish to open, then your focus clinically is on a patient, exactly like that actually, it wasn't me that have a frog in my throat, it is the fact that my left atrium was obstructing my...

    About the Lecture

    The lecture Valvular Heart Disease: Mitral Stenosis by Carlo Raj, MD is from the course Valvular Heart Disease. It contains the following chapters:

    • Mitral Stenosis
    • Pathogenesis
    • Visualisation
    • Signs & Symptoms
    • Diagnosis & Treatment

    Included Quiz Questions

    1. Mid-diastole, difficulty in opening
    2. Early-diastole, difficulty in closing
    3. Holosystolic, difficulty in opening
    4. Late systolic, difficulty in opening
    5. Pansystolic, difficulty in opening and closing
    1. Left ventricle
    2. Right ventricle
    3. Pulmonary veins
    4. Right atrium
    5. Left atrium
    1. Rheumatic heart disease.
    2. Congenital mitral stenosis.
    3. Bicuspid valve.
    4. Low output-cardiac failure.
    5. Pericarditis.
    1. Left atrium
    2. Left ventricle
    3. Right atrium
    4. Pulmonary vessels
    5. Right ventricle
    1. PCWP of 21 mmHg
    2. Central venous pressure of 7 mmHg
    3. Left atrial pressure of 9 mmHg
    4. Left ventricular systolic pressure of 120 mmHg
    5. Right ventricular systolic pressure of 25 mmHg
    1. P wave corresponding with the left atrial kick.
    2. Q wave corresponding with depolarization of the interventricular septum.
    3. T wave corresponding with repolarization of the ventricles.
    4. QRS complex corresponding with ventricular isovolumetric contraction.
    5. Delta wave associated with short PR interval.
    1. y-descent
    2. a-wave
    3. x-descent
    4. c wave
    5. v wave
    1. It is formed by atrial contraction.
    2. It represents bulging of the mitral leaflets back into the left atrium.
    3. It corresponds with isovolumetric contraction.
    4. It's only seen in 50% of patients.
    5. It represents early ventricular systole.
    1. It is usually followed by the y-descent.
    2. It occurs directly before diastole.
    3. It represents the portion of the cardiac cycle when the atria is most full.
    4. It is associated with opening of the mitral valve.
    5. It is the point in the cardiac cycle where the ventricle has the least volume.
    1. S2 directly following by opening snap, and then a mid-diastolic rumble.
    2. The opening snap occurs later in diastole in severe mitral stenosis compared to early mitral stenosis.
    3. The murmur extends across more of diastole in severe mitral stenosis compared to early mitral stenosis.
    4. A mid-systolic click is an added sound in severe mitral stenosis that is not present in early mitral stenosis.
    5. The murmur is best heard closer to the apex in severe mitral stenosis and closer to the 2nd intercostal space in mild mitral stenosis.
    1. Laterally displaced apex.
    2. Dysphagia.
    3. Hoarseness.
    4. Hemoptysis.
    5. Dyspnea on exertion.
    1. Compression of left recurrent laryngeal nerve.
    2. Increased hydrostatic pressure in the pulmonary veins.
    3. Compression of the vagus nerve.
    4. Decreased blood supply to the vocal cords.
    5. Pulmonary edema leading to upper respiratory tract infection.
    1. Cor pulmonale is the result of a primary lung condition, while RHF in mitral stenosis is secondary to left heart failure.
    2. RHF in mitral stenosis is due to cor pulmonale.
    3. RHF in mitral stenosis is the result of long standing pulmonary edema similar to cor pulmonale.
    4. Cor pulmonale is the result of a primary lung condition, while RHF in mitral stenosis is due to backflow of blood into the right ventricle.
    5. Cor pulmonale is the result of a primary lung condition, while RHF in mitral stenosis is the result of compression from the enlarged left atrium.
    1. Opening snap followed by mid-diastolic rumble.
    2. Mid-systolic click with mid-diastolic rumble.
    3. Systolic crescendo-decrescendo murmur.
    4. Early diastolic decrescendo murmur.
    5. High-pitched holosystolic murmur.
    1. Right ventricular failure
    2. Pulmonary capillary wedge pressure of > 20 mmHg
    3. Left atrial pressure > 15
    4. Dysphagia
    5. Voice hoarseness
    1. Increased risk of atrial fibrillation.
    2. Endothelial injury
    3. Coagulation disorder
    4. Bleeding diathesis
    5. Heart pump failure

    Author of lecture Valvular Heart Disease: Mitral Stenosis

     Carlo Raj, MD

    Carlo Raj, MD


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    Highlighted patho-physiology
    By Mariane B. on 27. February 2017 for Valvular Heart Disease: Mitral Stenosis

    This is after all a Pathology course. Normally, management is not discussed here, but you guys did. Thank you!

     
    What about valvuloplasty
    By Hamed S. on 18. February 2017 for Valvular Heart Disease: Mitral Stenosis

    Need to further explore surgical and percutaneous treatment options incl valvuloplasty and in which patients valve replacement vs valvuloplasty is preferred