MITRAL STENOSIS
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