Internal Diseases · MU Plovdiv

19. Mitral stenosis and insufficiency

Inside: 19 sections · 7 labelled pictures · 3 tables · 32 flashcards · 17 min

Topic 33 of 74 in the MU Plovdiv syllabus for Internal Diseases (Dental Medicine, Year 3). The free AceMed note covers it in 19 sections, about 2,295 words (17 min of reading), with 32 flashcards.

In this note

  1. Mitral Stenosis
  2. Definition:
  3. Etiology:
  4. Pathophysiology:
  5. Symptoms:
  6. Physical Examination:
  7. Lab Tests:
  8. Instrumental tests
  9. Complications:
  10. Definition
  11. Etiology
  12. Pathophysiology and haemodynamics
  13. Classification
  14. Clinical features
  15. Diagnosis
  16. Differential diagnosis
  17. Treatment
  18. Complications
  19. Prognosis

Definition:

  • Mitral stenosis is the narrowing of the mitral valve orifice, normally 3–6 cm².
  • Clinically significant if < 1.5 cm².
  • Can be congenital or more commonly acquired.

Etiology:

  • Rheumatic fever (most common cause)
  • Congenital malformations (less common)

Pathophysiology:

  1. Narrowed mitral valve restricts blood flow from LA to LV during diastole.
  2. ↑ LA pressure to push blood into LV → LA hypertrophy then dilatation
  3. Blood backs up into pulmonary veins → ↑ pulmonary venous pressure → pulmonary congestion and edema
  4. Pulmonary HTN develops due to chronic back pressure → RV pressure overload → RV hypertrophy → RV failure
  5. Stretched LA → increased irritability of atrial conduction system → Atrial fibrillation
  6. Stagnant flow in dilated LA → thrombus formation → embolism risk
  7. Staging:
  • Stage I: LA hypertrophy, mild pulmonary congestion
  • Stage II: Pulmonary hypertension, RV and RA dilatation, systemic venous congestion (right heart failure signs)

Symptoms:

  • Dyspnea on exertion
  • Orthopnea, PND (paroxysmal nocturnal dyspnea)
  • Fatigue
  • Peripheral cyanosis
  • Palpitations (especially with AF)
  • Hemoptysis (from ruptured bronchial veins)
  • Thromboembolic events (e.g., stroke)
  • Ascites and peripheral edema (late, due to RHF)
  • Angina (occasionally)

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