Mitral Stenosis is narrowing of the mitral valve, leading to obstruction of blood flow from the left atrium (LA) to the left ventricle (LV).
Most Common Cause: Rheumatic Heart Disease (RHD)
Mnemonic: "MS = Mitral Shrinking (Narrow Valve)"
CAUSES OF MITRAL
STENOSIS
1. Common Causes
• Rheumatic Heart Disease (RHD) – Most Common
• Congenital MS (Born with a Narrow Mitral Valve)
• Mitral Valve Calcification (Aging, Chronic Kidney Disease)
• Infective Endocarditis (Vegetations Blocking the Valve)
Mnemonic: "R.C.C.I." (Rheumatic, Congenital, Calcification, Infection)
PATHOPHYSIOLOGY
OF MS
- Mitral Valve Narrows → Blood Stagnates in Left Atrium
- Left Atrium Enlarges → Increased Pressure in Lungs
- Pulmonary Hypertension Develops → Right Heart Overload
- Late Stage → Right Heart Failure, Atrial Fibrillation & Blood Clots
Mnemonic: "N.E.P.H.R." (Narrowing → Enlarged LA → Pulmonary HTN → Heart Fails → Right Side Involvement)
SYMPTOMS OF
MITRAL STENOSIS
• Breathlessness on Exertion (Due to Lung Congestion)
• Palpitations (Due to Atrial Fibrillation)
• Fatigue (Low Cardiac Output)
• Cough with Blood (Hemoptysis – Due to Ruptured Lung Vessels)
• Right Heart Failure (Swelling of Legs, Liver Congestion, Ascites)
Mnemonic: "B.P.F.H.R." (Breathless, Palpitations, Fatigue, Hemoptysis, Right Heart Failure)
SIGNS & HEART
SOUNDS IN MS
Pulse: Small & Irregular (Atrial Fibrillation in
Late Stages).
Apex Beat: Tapping Apex (Due to LA Overload).
Heart Sounds:
- Loud S1 (Mitral Valve Closing Sound)
- Opening Snap (OS) – Mitral Valve
Opening Sound (KEY SIGN!)
- Diastolic Murmur – Low-Pitched
Rumbling Best Heard at Apex.
Mnemonic: "T.O.D." (Tapping Apex, Opening Snap, Diastolic Murmur)
DIAGNOSIS OF
MITRAL STENOSIS
ECG:
- P Mitrale (Wide, Notched P Wave = LA
Enlargement)
- Right Ventricular Hypertrophy (RVH) if
Pulmonary HTN Present
Chest X-ray:
- Enlarged Left Atrium ("Double
Shadow Sign")
- Pulmonary Congestion
Echocardiography (Best Test!)
- Shows Narrowed Mitral Valve & LA
Enlargement
Mnemonic: "E.C.E." (ECG, CXR, Echo – Best Test)
TREATMENT OF
MITRAL STENOSIS
1. MEDICAL
TREATMENT (For Mild Cases)
Diuretics (Reduce Lung Congestion & Edema)
Beta-Blockers (Slow Down Heart Rate, Allow Better Filling)
Anticoagulants (Prevent Blood Clots in Atrial Fibrillation)
Penicillin Prophylaxis (Prevent Recurrent Rheumatic Fever)
Mnemonic: "D.B.A.P." (Diuretics, Beta-Blockers, Anticoagulants, Penicillin)
2. SURGICAL
TREATMENT (For Severe MS)
Balloon Mitral Valvuloplasty (BMV) – First Choice!
Mitral Valve Replacement (If Valve is Too Calcified or Fibrosed)
Mnemonic: "B.M.V." (Balloon, Mitral, Valvuloplasty)
COMPLICATIONS OF
MS
• Atrial Fibrillation (Due to Stretched LA)
• Blood Clots (Causing Stroke or Limb Ischemia)
• Heart Failure (Right Heart Fails Due to Lung Pressure)
• Pulmonary Hypertension
Mnemonic: "A.B.H.P." (AFib, Blood Clots, Heart Failure, Pulmonary HTN)
DIFFERENTIAL
DIAGNOSIS (CONDITIONS THAT MIMIC MS)
Left Atrial Myxoma (Tumor Blocking Mitral Valve).
Congenital MS (Parachute Mitral Valve).
Cor Triatriatum (Membrane in Left Atrium).
Mnemonic: "M.C.C." (Myxoma, Congenital MS, Cor Triatriatum)
PREVENTION OF
MITRAL STENOSIS
Early Treatment of Rheumatic Fever (Penicillin Prophylaxis).
Regular Follow-up for Valve Disease.
Lifestyle Changes (Avoid High Salt Diet in Heart Failure
Patients).
Mnemonic: "P.R.L." (Penicillin, Regular Follow-up, Lifestyle Change)
FINAL REVISION WITH MNEMONICS
- Definition = "MS = Mitral Shrinking (Narrow Valve)"
- Causes = "R.C.C.I." (Rheumatic, Congenital, Calcification, Infection)
- Pathophysiology = "N.E.P.H.R." (Narrowing → Enlarged LA → Pulmonary HTN → Heart Fails → Right Side Involvement)
- Symptoms = "B.P.F.H.R." (Breathless, Palpitations, Fatigue, Hemoptysis, Right Heart Failure)
- Signs & Murmurs = "T.O.D." (Tapping Apex, Opening Snap, Diastolic Murmur)
- Diagnosis = "E.C.E." (ECG, CXR, Echo – Best Test)
- Medical Treatment = "D.B.A.P." (Diuretics, Beta-Blockers, Anticoagulants, Penicillin)
- Surgical Treatment = "B.M.V." (Balloon, Mitral, Valvuloplasty)
- Complications = "A.B.H.P." (AFib, Blood Clots, Heart Failure, Pulmonary HTN)
- Differential Diagnosis = "M.C.C." (Myxoma, Congenital MS, Cor Triatriatum)
- Prevention = "P.R.L." (Penicillin, Regular Follow-up, Lifestyle Change)
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