Mitral stenosis

The normal area of the mitral valve is 4-6cm ^2

Mild mitral stenosis: area 1.6-2cm^2 with a mean pressure drop of <5mmHg
Severe mitral stenosis: area <1cm^2 with a mean pressure drop of >10mmHg 

  • Most commonly rheumatic fever 
  • Rarely: 
    • Carcinoid syndrome 
    • Weight loss medications 

  • Exertional dyspnoea 
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Haemoptysis – due to pulmonary hypertension causing rupture of anastomoses of bronchial veins 
  • Rarely –horseness due to compression of left recurrent laryngeal nerve 

On examination 
  • Mitral facies 
  • AF – 40% 
  • Loud S1 (or absent S1 in severe disease)
  • Opening snap 
  • Rumbling mid-diastolic murmur 
  • Occasionally – high-pitched blowing murmur at cardiac base = Graham Steell murmur
  • If pulmonary hypertension has developed: 
    • Hepatomegaly 
    • Ascites 
    • Oedema 

Diagnosis is usually by echocardiography

  • Medications 
    • Diuretics/long-acting nitrates to improve dyspnoea 
    • Beta-blockers/calcium channel blockers may improve exercise tolerance 
    • Anticoagulate if AF 
  • Percutaneous mitral commissurotomy (=balloon dilation) 
    • Indicated if valve area <1.5cm^2 AND
      • symptomatic OR 
      • asymptomatic but at high risk of embolism OR 
      • haemodynamic decompensation 
    • Risks: 
      • Mortality 0.5-4% 
      • Haemopericardium 0.5-10% 
      • Embolism 0.5-5% 
      • Severe MR 2-10%
  • Surgery 

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Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)