Covers mitral stenosis, from its definition by valve orifice area and its main causes, mainly rheumatic fever, through the chain of pathophysiological events in the left atrium, pulmonary circulation and right heart. It then lists symptoms and stage-by-stage physical findings, including facies mitralis and the diastolic murmur, followed by lab tests, ECG and chest X-ray features, echocardiographic grading by valve area and transmitral gradient, catheterisation, and complications.
Topic 18 of 58 in the MU Sofia syllabus for Internal Medicine (Theory) (Medicine, Year 3). The free AceMed note covers it in 9 sections, about 450 words (3 min of reading), with 16 flashcards.
In this note
Mitral Stenosis
Definition:
Etiology:
Pathophysiology:
Symptoms:
Physical Examination:
Lab Tests:
Instrumental tests
Complications:
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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