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Mitral Stenosis (Examination (Precordium (Murmur (Pre-systolic…

- - - - Prosthetic valve
      - Congenital
  - - - Loud S1
      - ± loud P2 (if PHT)
      - Early diastolic opening snap
    - - Rumbling MDM
      - Apex
      - Left lateral position in end expiration
      - With the Bell
      - Radiates to the axilla
      - Pre-systolic accentuation if pt. in sinus rhythm
        
        Atrial contraction
  - - - Malar flush
      - ↑ JVP w/ large V waves
      - Left parasternal heave
      - Loud P2
    - - AR
      - Right-sided: PR, TS
- - - - LA hypertrophy → splaying of carina
      - Calcified mitral valve
      - Pulmonary oedema
    - - Severity
      - Cusp calcification
      - LV function
      - Other valve function
      - TOE: left atrial thrombus if intervention planned
    - - Valve orifice <1cm2
      - Pressure gradient >10mmHg
      - Pulmonary artery systolic pressure >50mmHg
    - - Assess coronaries (needed if surgery planned)
      - Grade severity
  - - - MDT: GP, cardiologist, cardiothoracic surgeon, dietician, specialist nurses
      - Optimise CV risk: statins, anti-HTN, DM, anti-plat
      - Monitor: regular f/up and echo
    - - Consider rheumatic fever prophylaxis: e.g. Pen V
      - AF
        Rate control: β-B
        Anticoagulate (4% stroke risk /yr)
      - Diuretics provide symptom relief
    - - Indicated in mod–severe MS (asympto and symptomatic)
      - Percutaneous balloon valvuloplasty
        
        Rx of choice
        
        Suitability depends on valve characteristics
        
        Pliable, minimally calcified
        
        CI if left atrial mural thrombus
      - Surgical valvotomy / commissurotomy: valve repair
      - Valve replacement if repair not possible