Mitral Stenosis

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Presentation :

• Most common symptoms are fatigue, orthopnea, and paroxysmal nocturnal dyspnea
• Commonly associated with AFib 2/2 L atrial dilation

Pathophysiology :

Diagnostic Testing:

• Chest x-ray shows an enlarged pulmonary artery, left atrium, right ventricle, and right atrium.
• ECG shows RV hypertrophy and a notched P-wave duration >0.12 s in lead II (P mitrale).
• TTE is used to assess disease severity of mitral stenosis by measuring valve area and transvalvular gradient. TEE provides better visualization for the presence of left atrial appendage thrombus.

Treatment :

• Balloon valvuloplasty is first-line therapy for symptomatic patients and for asymptomatic patients with severe mitral stenosis or moderate mitral stenosis associated with PH.
• Medical therapy with:
  • Diuretics or long-acting nitrates, which may help improve symptoms such as dyspnea.
  • β-blockers or nondihydropyridine calcium channel blockers can lower HR and improve LV diastolic filling time.
• Treat all patients with mitral stenosis and AFib with warfarin (for valvular AFib) regardless of CHA2DS2-VASc score.

Prognosis:

References: