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23 Cards in this Set
- Front
- Back
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Etiology of Mitral stenosis (MS) |
rheumatic fever!!! |
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mitral stenosis is a... |
right sided heart problem |
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rheumatic process |
immobility and thickening of mitral valve leaflets and fusion of commissures = turbulent flow and calcification of the valve |
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pathophysiology of MS |
obstruction -> incr. left atrial pressure -> incr. pulmonary venous & capillary pressures -> reflex pulmonary arteriolar constriction -> pulm. hyperT -> right ventricular hypertrophy -> RV failure |
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heart compensates for the difficulty in filling the LV by |
increasing the pressure in the left atrium |
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loss of atrial contraction (A-fib) in MS patient results in |
20% reduction in cardiac output |
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symptoms of MS |
fatigue, decr. exercise tolerance dyspnea w/ cough and wheezing, hemoptysis, chest pain (w/ severe RV hypertension), palpitations, thromboembolism |
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MS patients are at increased risk for |
thromboembolism |
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physical exam in MS |
PMI usually quiet; if significant pulm. hypertension and RV hypertrophy, PMI can have left parasternal systolic lift |
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Jugular venous system |
prominent A wave (corresponds w/ pulmonary hypertension) peak of wave = end of atrial systole |
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arterial pulse in MS |
usually normal |
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S1 in MS |
accentuated - elevated LA pressure doesn't allow leaflets to float to a closed position |
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S2 in MS |
accentuated P2 component due to pulmonary hypertension |
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distinct heart sound in MS |
opening snap |
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what is the opening snap? |
occurs as mitral valve abruptly stops opening into the LV during diastole - caused by stenosis heard best at apex and left sternal border |
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Murmur of MS |
low pitched rumbling diastolic murmur, beings right after opening snap, heard best at apex accentuate again late in diastole assoc. w/ atrial contraction |
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Chest x-ray in MS |
may show subtle left atrial enlargement, but otherwise normal |
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EKG in MS |
shows right axis deviation |
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Cardiac catheterization in MS |
shows high pressure in left atrium as compared to the left ventricle |
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Management of MS |
prevent recurrent rheumatic fever, SBE prophylaxis before dental procedures, diuretics, arrhythmia treatment, anticoagulation |
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Surgery in MS |
recommended when there are significant symptoms - open valvotomy, mitral valve replacement, balloon valvuloplasty |
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open valvotomy |
surgeon manually releases adhesions and forces the valves - not often done |
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balloon valvuloplasty |
works well b/c generally not very much calcification; releases adhesions |
