📋 HISTORY
A 38-year-old woman presents with progressive breathlessness and orthopnea for 3 months.
🔹 History of rheumatic fever in childhood
――――――――――――――
🩺 EXAMINATION
🔹 Pulse: 110/min, irregularly irregular
🔹 JVP raised
🔹 Loud S1, opening snap, mid-diastolic murmur at apex
🔹 Pansystolic murmur radiating to axilla
🔹 Bilateral basal crepitations
――――――――――――――
🩻 CXR FINDINGS
🔹 Cardiomegaly (transverse diameter enlarged)
🔹 Prominent pulmonary conus
🔹 Prominent right-sided pulmonary artery
🔹 Wide carinal angle
🔹 Straightening of left cardiac border
――――――――――――――
❓ QUESTION
Which single investigation is MOST useful to confirm the diagnosis and guide management?
https://www.effectivecpmnetwork.com/p6x5cixrpy?key=0e3ba72754512fdd23ee8b77a5e394ed
A 38-year-old woman presents with progressive breathlessness and orthopnea for 3 months.
🔹 History of rheumatic fever in childhood
――――――――――――――
🩺 EXAMINATION
🔹 Pulse: 110/min, irregularly irregular
🔹 JVP raised
🔹 Loud S1, opening snap, mid-diastolic murmur at apex
🔹 Pansystolic murmur radiating to axilla
🔹 Bilateral basal crepitations
――――――――――――――
🩻 CXR FINDINGS
🔹 Cardiomegaly (transverse diameter enlarged)
🔹 Prominent pulmonary conus
🔹 Prominent right-sided pulmonary artery
🔹 Wide carinal angle
🔹 Straightening of left cardiac border
――――――――――――――
❓ QUESTION
Which single investigation is MOST useful to confirm the diagnosis and guide management?
🅐 CT pulmonary angiography
🅑 Cardiac catheterization
🅒 Color Doppler echocardiography
🅓 Chest X-ray PA view
❓ FAQ: Mitral Stenosis
1. What is the most common cause of mitral stenosis?
Rheumatic heart disease, due to chronic inflammation and fibrosis of the mitral valve leaflets.
2. What is the characteristic murmur?
A low-pitched mid-diastolic rumbling murmur heard best at the apex, often with an opening snap.
3. Why does an opening snap occur?
Due to sudden halting of a stiffened mitral valve as it opens in early diastole.
4. What rhythm disturbance is commonly associated?
Atrial fibrillation, due to left atrial enlargement and stretch.
5. Why does atrial fibrillation increase stroke risk?
Stasis of blood in the dilated left atrium predisposes to thrombus formation and embolism.
6. What are the symptoms of mitral stenosis?
Progressive breathlessness, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and fatigue.
7. What CXR findings are typical?
Cardiomegaly, prominent pulmonary conus, double right heart border, and straightening of the left heart border.
8. What is the gold standard investigation?
Color Doppler echocardiography, which assesses valve area, gradient, and severity.
9. What defines severe mitral stenosis?
A valve area less than 1.0 cm² on echocardiography.
10. What is the role of ECG?
May show P mitrale (broad notched P waves) indicating left atrial enlargement, or atrial fibrillation.
11. What medical treatments are used?
Diuretics for congestion, beta-blockers/rate control for AF, and anticoagulation if AF is present.
12. What interventional treatment is preferred in suitable patients?
Percutaneous balloon mitral valvotomy (PBMV) in patients with favorable valve anatomy.
13. When is surgery indicated?
When valve anatomy is unsuitable for PBMV or significant calcification/regurgitation is present.
14. What is a major complication of untreated mitral stenosis?
Pulmonary hypertension leading to right heart failure.
15. Why is endocarditis prophylaxis relevant?
Damaged valves are at increased risk of infective endocarditis during certain procedures.
1. What is the most common cause of mitral stenosis?
Rheumatic heart disease, due to chronic inflammation and fibrosis of the mitral valve leaflets.
2. What is the characteristic murmur?
A low-pitched mid-diastolic rumbling murmur heard best at the apex, often with an opening snap.
3. Why does an opening snap occur?
Due to sudden halting of a stiffened mitral valve as it opens in early diastole.
4. What rhythm disturbance is commonly associated?
Atrial fibrillation, due to left atrial enlargement and stretch.
5. Why does atrial fibrillation increase stroke risk?
Stasis of blood in the dilated left atrium predisposes to thrombus formation and embolism.
6. What are the symptoms of mitral stenosis?
Progressive breathlessness, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and fatigue.
7. What CXR findings are typical?
Cardiomegaly, prominent pulmonary conus, double right heart border, and straightening of the left heart border.
8. What is the gold standard investigation?
Color Doppler echocardiography, which assesses valve area, gradient, and severity.
9. What defines severe mitral stenosis?
A valve area less than 1.0 cm² on echocardiography.
10. What is the role of ECG?
May show P mitrale (broad notched P waves) indicating left atrial enlargement, or atrial fibrillation.
11. What medical treatments are used?
Diuretics for congestion, beta-blockers/rate control for AF, and anticoagulation if AF is present.
12. What interventional treatment is preferred in suitable patients?
Percutaneous balloon mitral valvotomy (PBMV) in patients with favorable valve anatomy.
13. When is surgery indicated?
When valve anatomy is unsuitable for PBMV or significant calcification/regurgitation is present.
14. What is a major complication of untreated mitral stenosis?
Pulmonary hypertension leading to right heart failure.
15. Why is endocarditis prophylaxis relevant?
Damaged valves are at increased risk of infective endocarditis during certain procedures.
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