Cardiovascular Medicine Book


Mitral Stenosis

Aka: Mitral Stenosis
  1. Causes
    1. Rheumatic Fever
    2. Congenital Mitral Stenosis
  2. Pathophysiology
    1. Increased left atrial pressure
      1. Pulmonary Vasoconstriction
      2. Pulmonary Hypertension
      3. Right Ventricular Failure
    2. Decreased Cardiac Output
  3. Symptoms
    1. Symptoms of Left Ventricular Failure
      1. Dyspnea on exertion
      2. Orthopnea
      3. Paroxysmal Nocturnal Dyspnea
      4. Cough
    2. Symptoms of Right Ventricular Failure
    3. Other Symptoms
      1. Hemoptysis
    4. Precipitating Factors
      1. Exertion
      2. Fever
      3. Anemia
      4. Pregnancy
      5. Sexual intercourse
      6. Atrial Fibrillation
  4. Signs: Precordial Exam
    1. Diastolic Thrill
    2. Diastolic Murmur at apex
      1. Apical, low pitched rumbling in mid-diastole
      2. Loudest in early diastole
      3. Crescendo at end of diastole (presystolic)
      4. Accentuating factors
        1. Left lateral decubitus position
        2. Stethoscope bell
        3. Brief Exercise (e.g. brief walk in hallway)
    3. Opening snap of mitral valve cusp
      1. Heard at 3rd - 4th interspace at left sternal border
    4. Accentuated P2 heart sound
    5. Accentuated M1 heart sound
    6. Diminished M2 heart sound
  5. Signs: Later findings of Right Ventricular Failure
    1. Accentuated precordial thrust of right ventricle (lift)
    2. Elevated neck veins
    3. Ascites
    4. Edema
  6. Complications
    1. Hemoptysis
    2. Pulmonary Embolism
    3. Pulmonary infection
    4. Systemic emboli
    5. Endocarditis (uncommon)
  7. Electrocardiogram
    1. Atrial Fibrillation
      1. Occurs secondary to severe atrial hypertrophy
      2. Most common complication of Mitral Stenosis
      3. High risk for Thromboembolism (esp. Cerebrovascular Accident)
    2. Left atrial enlargement
      1. Stenosed mitral valve impedes flow from left atrium to left ventricle
    3. Signs Pulmonary Hypertension
      1. Right Axis Deviation
      2. Right Ventricular Hypertrophy
  8. Imaging
    1. Chest XRay
      1. Left atrial enlargement
      2. Right Ventricular Enlargement
      3. Posterior displacement of esophagus
      4. Mitral valve calcification
      5. Kerley B Lines
    2. Echocardiogram (Study of choice)
      1. Mitral valve leaflet changes
        1. Inadequate separation of valve leaflets
        2. Valve leaflet calcification and thickening
      2. Doppler estimates transvalvular gradient
  9. Course
    1. Slow, progressive, life-long course
    2. Latent period of 20 to 40 years after Rheumatic Fever
    3. Rapid acceleration of symptoms in later life
  10. Management
    1. Rheumatic Fever prophylaxis until age 35 years
      1. Benzathine Penicillin G 1.2 MU IM qMonth OR
      2. Penicillin VK 125-250 mg PO bid
    2. SBE Prophylaxis
    3. Treat complications and associated conditions
      1. Atrial Fibrillation
      2. Congestive Heart Failure
      3. Anticoagulation for history of emboli
    4. Surgery
      1. Open Mitral valvuloplasty Indications
        1. Mitral orifice <= 1.2 cm2
        2. Cardiopulmonary symptoms
        3. Not a candidate for balloon valvotomy
      2. Percutaneous balloon valvuloplasty (Valvotomy)
        1. Indications
          1. NYHA Class II, III, IV moderate Mitral Stenosis
        2. Contraindications
          1. Non-pliable or calcified valve
          2. Subvalvular distortion
          3. No significant Mitral Regurgitation
  11. References
    1. Kondos (1998) CMEA Medicine Review Lecture, San Diego
    2. Assi (1998) Postgrad Med 104(6):99-110 [PubMed]
    3. Bonow (1998) Circulation 98:1949-84 [PubMed]
    4. Carabello (1997) N Engl J Med 337(1):32-41 [PubMed]
    5. Shipton (2001) Am Fam Physician 63(11):2201-8 [PubMed]

Mitral Valve Stenosis (C0026269)

Definition (CHV) narrowing of a heart valve
Definition (CHV) narrowing of a heart valve
Definition (CHV) narrowing of a heart valve
Definition (NCI) Narrowing of the left atrioventricular mitral orifice.
Definition (NCI_FDA) Narrowing of the left atrioventricular mitral orifice.
Definition (CSP) rheumatic disease causing diffuse thickening of the mitral valve leaflets by fibrous tissue or calcific deposits.
Definition (MSH) Narrowing of the passage through the MITRAL VALVE due to FIBROSIS, and CALCINOSIS in the leaflets and chordal areas. This elevates the left atrial pressure which, in turn, raises pulmonary venous and capillary pressure leading to bouts of DYSPNEA and TACHYCARDIA during physical exertion. RHEUMATIC FEVER is its primary cause.
Concepts Disease or Syndrome (T047)
MSH D008946
SnomedCT 194725005, 155277002, 79619009
English Mitral Valve Stenoses, Mitral Valve Stenosis, Stenoses, Mitral Valve, Valve Stenoses, Mitral, Valve Stenosis, Mitral, Stenosis, Mitral Valve, Mitral Stenoses, Mitral Stenosis, Stenoses, Mitral, Stenosis, Mitral, mitral stenosis, mitral stenosis (diagnosis), Mitral Valve Stenosis [Disease/Finding], MS, mitral valve stenosis, MITRAL STENOSIS, STENOSIS, MITRAL, Mitral stenosis, MS - Mitral stenosis, Mitral valve stenosis, Mitral valve stenosis (disorder), mitral; stenosis, mitral; stricture, stenosis; mitral, stricture; mitral, Mitral valve stenosis, NOS
Dutch mitralisstenose, mitraal; stenose, mitraal; strictuur, stenose; mitraal, strictuur; mitraal, mitralisklepstenose, Mitralisklepstenose, Mitralisstenose, Stenose, mitralisklep-
Spanish Estenosis mitral, estenosis de la válvula mitral (trastorno), estenosis de la válvula mitral, estenosis mitral, Estenosis de la válvula mitral, Estenosis de la Válvula Mitral, Estenosis Mitral
Swedish Mitralklafförträngning
Japanese ソウボウベンキョウサクショウ, 僧帽弁狭窄症, 左房室弁狭窄症, 僧帽弁狭窄
Finnish Hiippaläpän ahtauma
French Sténose valvulaire mitrale, Rétrécissement valvulaire mitral, STENOSE MITRALE, Sténose de la valve mitrale, Rétrécissement mitral, Sténose mitrale, Rétrécissement de la valve mitrale
Portuguese ESTENOSE MITRAL, Estenose mitral, Estenose da Valva Mitral, Estenose Mitral
German MITRALSTENOSE, Mitralklappenstenose, Mitralstenose
Czech Mitrální stenóza, Stenóza mitrální chlopně, mitrální stenóza, mitrální chlopeň - stenóza
Italian Stenosi della valvola mitralica, Stenosi della valvola mitrale, Stenosi mitralica
Polish Stenoza mitralna, Zwężenie mitralne, Zwężenie zastawki dwudzielnej, Zwężenie zastawki mitralnej
Hungarian Mitralis szűkület, Mitralis billentyű stenosis
Norwegian Mitralstenose
Derived from the NIH UMLS (Unified Medical Language System)

You are currently viewing the original '\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree