Introduction
-The mitral valve has two leaflets, anterior and posterior
-Mitral stenosis is a condition where the mitral valve area is reduced, causing obstruction of blood flow from the left atrium into the left ventricle during left ventricular diastole
-MS can cause elevated left atrial pressure resulting in pulmonary hypertension, pulmonary edema, and right heart failure.
-the most common cause of mitral valve stenosis: Rheumatic heart disease
-Other causes include congenital, SLE, RA, myxoma
Symptoms & signs
-Rosy cheeks (mitral facies), Fatigue, exertional dyspnea, orthopnea, heart failure, atrial fibrillation, pulmonary hypertension, right-sided heart failure (ascites, pedal edema, weight gain), hemoptysis, hoarseness of voice (Ortner syndrome), systemic embolization
-Accentuated first heart sound, an opening snap following the second heart sound, mid-diastolic low-pitched rumbling murmur best heard at the apex with the patient in the left lateral position
Diagnosis
ECG: tall peaked P waves, broad bifid P waves (P mitrale), right axis deviation, LA abnormality, atrial fibrillation
Echocardiography: thickened mitral valve leaflets, fish-mouth appearance of mitral valve, “hockey-stick” motion of the anterior leaflet, enlarged left atrium
Chest x-ray: Left atrial enlargement, horizontal lines in the regions of the costophrenic angles representing interstitial edema (Kerley A and B lines)
Treatment
Asymptomatic: no treatment
Symptomatic: Balloon valvuloplasty or valve replacementMedications: diuretics, beta blockers,calcium channel blockers, anticoagulants