MITRAL STENOSIS

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Thickened MV leaflets with decreased mobility . Tethered MV leaflet tips (hockey - stick) LEFT ATIRAL ENLARGEMENT Signs of pulmonary hypertension in advanced disease. RV & RA enlargement

2D

Significant AI and or AS can cause and underestimation of MITRAL STENSOIS due to INCREASED ___ ___ ____.

DIASTOLIC LV PRESSURE

Acquired (Mitral annular calcification MAC)

ETIOLOGIES of Mitral Stenosis

Congenital (rare) (parachute)

ETIOLOGIES of Mitral Stenosis

Prosthetic valve dysfunction

ETIOLOGIES of Mitral Stenosis

Rheumatic (most common) Congenital (rare) (parachute) Acquired (Mitral annular calcification MAC) Prosthetic valve dysfunction

ETIOLOGIES of Mitral Stenosis?

LEFT ATRIAL ENLARGEMENT Large RIGHT VEBTRICLE and PULMONARY ARTERY if pulmonary hypertension is present.

FINDING of a PATIENTS with MS

400 X0.29=116 DECELERATION TIME x 0.29 =

Given a mitral deceleration time of 400 m/sec calculate the mitral valve pressure half - time.

220/400=0.5cm2

Given a mitral pressure half - time of 400 m/sec what would the area be? A) 0.5 cm2 C) 1.8 cm2 B) 1.0 cm2 D) 2.0 cm2

Longstanding MS leads to all the following EXCEPT? A) congestive heart failure B) pulmonary hypertension C) left ventricular dilatation D) left atrial dilatation

LEFT VENTRICULAR DILATION

REFERS to the presence of acquired MITRAL STENOSIS an associated OSTIUM SECUNDUM ASD

LUTEMBACHER'S SYNDROME

A) congestive heart failure B) pulmonary hypertension C) left atrial dilatation

Longstanding MS leads to all the following

Associated with ATRIAL FIBRILLATION

MITRAL STENOSIS

Is a VALVULAR DISEASE in which the MITRAL VALVE ORIFICE is NARROWED so that the VALVE CANNOT OPEN fully.

MITRAL STENOSIS

• Mild • Moderate • Severe <1.0 cm2

MITRAL VALVE AREA

LOW FREQUENCY "Diastolic Rumble"

MS MURMUR

• Most common cause: RHEMATIC HEART

Mitral Stenosis

• Mild - P ½ time = 90-150ms • Moderate - P ½ time = 150-220ms • Severe - P ½ time = >220ms

PRESSURE HALF TIME

Because of RA and RV ENLARGEMENT there is SIGN of

PULMONARY HTN

• Balloon valvuloplasty • Commissurotomy • Valve repair or replacement

Treatment:

Mild - > 1.5 MVA (cm2) , <5 mean grad, <30 Pulmonary artery pressure Moderate - 1.0 - 1.5 MVA, 5 -10 mean grad, 30 - 50 PA pressure Severe - <1.0 MVA, >10 mean grad, >50 PA pressure

What are the guidelines for Mitral Stenosis?

Normal - 4 -5 cm2 Mild - > 1.5 cm2 Moderate - 1.5 - 1cm2 Severe - <1cm2

What are the measurements for Mitral Valve Area?

PULMONIC

Which of the following valves is LEAST likely to be affected in rheumatic heart disease

averaged over 5 - 10 beats

With atrial fibrillation MITRAL SENOSIS velocity calculations are best performed:

LEAFLETS DOMED ( DIASTOLE) POSTERIOR LEAFELTS ( PARADOXIAL ANTERIOR MOTION with LEAFLET TETHERING) ANTIOR LEAFELT demonstrates a "HOCKEYSTICK" (DIASTOLE)

(Appearance for MITRAL STENOSIS)

DIASTOLIC MURMUR (rumble) with____ ____

OPENING SNAP

Hockey - Stick" presentation goes with

Rheumatic MS

CHF symptoms (dyspnea, fatigue, orthopnea, peripheral edema). Hemoptysis (bloody sputum).

SIGN in SYMPTOMS

Parachute MV used as potential answer on exam

SINGLE PAPILLARY MUSCLE

dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea (PND) Palpitations Chest pain Hemoptysis

SYMPTOMS of MS

MVA (DECELERATION) 759/DECELERATION TIME ( EQUATION) 759/400 =1,9cm2

To CONVERT DECELERATION TIME to MITRAL VALVE AREA


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