Mitral valvestenosis cvs-250203222750.pdf

Mitral valve stenosis

1. MITRAL V.
STENOSIS
Complications
- AF
- lt. Atrium myxoma
- lt. Atrium thrombosis
- pulmonary Hypertension
that cause Rt. Side heart
failure
Treatment
Valve Replacement if
Severe
Concore (BB) For AF
Diuretics and Warfarin
Clinical Features
Symptoms
Dyspnea and Dizziness
Hemoptysis
Chest Pain
Palpitation and odema
Systemic Embolization
Rt. Heart Failure
Hoarseness
Examination
Causes
Primary
Rhumatic Fever (Common)
Congenital
Infective Endocarditis
Connective Tissue Diseases
Lethargic drugs in obstetrics
Secondary
Dilatated Cardiomyopathy
Lt. Ventricular Hypertrophy
pt. with MS has Dyspnea and Hoarseness? Why..
Ortner Syndrome:- sever MS lead to
lt. Atrium enlargement that
compress on Lt. Recurrent laryngeal
nerve
Pt. has AF use Amiodarone
S/E of Amiodarone is Hypothyroidism lead
to hoarseness of sound
Inspection and Palpation In patients with severe MS,
there may be a malar flush with pinched and blue
facies.
Apex beat isn't displaced and Tapping Apex beat in
Character.
A diastolic thrill may be present at the cardiac
apex,with the patient in the left lateral recumbent
position.
Aucultation :
MS is weak pulse so use Pelt of stethoscope and Pt. in
Lat. postion & The first heart sound (S1) is usually
accentuated So either MS or AR (Differentiation b/w
them)
put the pelt on Apex and your hand in carotid A.
- In MS the sound is low and if heard is Mid D. Murmur
(Rumbiling)
-in AR the sound is loud( ejection is strong) and Late
D. Murmur in 3rd and 4th intercostal spaces
□DDx of Mid Rumbling D. Murmur
1- lt. Atrium thrombus
2- lt. Atrium myxoma
3- Sever MR ( pansystolic murmur)
4- AR
□ During the examination
must be determined the
Severity
1- opening snap (OS)
2- the length of murmur is
proportional to the severity of
MS
3- Graham steal murmur
This is diastolic murmur heard
in 2nd lt. Intercostal spaces
(pulmonary) due to
functional pulmonary
Regurge as result of
Pulmonary hypertension
4- Pulmonary Hypertension
5- pulmonary congestion
☆DDx of Malar
flush
1- MS
2- SLE: don't arrive
to nasal fold
opposite of Malar
flush
3- Myxoedema
(Hypothyroidism)
4- cold weather
5- polycethemia
6- carcinoid
syndrome
1- if Pt. Symptomatic and Moderate calcification do either Valvoplasty or Replacement.
2- Valve Replacement in ...
-Moderate and severe calcification
-Restruction
-AF
-Pulmonary Hypertension
-Thromboembolism
-Atrium thrombosis
3- pregnancy: valvoplasty in 2nd Trimester and Replacement after Birth..
Pathophysiology
☆ the normal mitral valve orifice is about
4-6 cm² in diastole.
Less than 1cm mean sever Stenosis
1-1.5 cm mean moderate Stenosis
1.5 - 2 cm mean mild
2.5 mean relative Stenosis
see any Reference For more details
Note : the pt. don't know that's has Mitral
stenosis until intra-atrium pressure more
than 25mmHg due to
- increase Pulmonary congestion
- increase venous pressure
- decrease CO
More Common in Young Women than Men
By/ Abdrabuh M.
Dr/ Amtulrahim