Pathophysiology Obstruction between LA and LV Pressure gradient Elevated LA pressure LA pressure increases at elevated HR Pulmonary vascular resistance elevated Pulmonary hypertension Right ventricular hypertrophy enlargement Systemic venous congestion
Pathophysiology • Obstruction between LA and LV. • Pressure gradient. • Elevated LA pressure. • LA pressure increases at elevated HR. • Pulmonary vascular resistance elevated. • Pulmonary hypertension • Right ventricular hypertrophy, enlargement. • Systemic venous congestion
Mitral stenosis-Classification TABLE 12-11 Severity of MS Severity of M S Mild Moderate Severel Parameter Mean gradient (mm Hgh 30 30-50 Valve area (cm2)v >15 1-15 >> 10
Mitral stenosis-Classification s √
Mitral stenosis Clinical Presentations Asym stomatic symptomatIc Dyspnea, PND, Orthopnea Hemoptysis-usually pulmonary venous hypertension -rupture of alveolar capillaries. pulmonary infarction. ruptured of dilated bronchial veins -chronic bronchitis sIgns of right-sided heart failure: in advanced disease ● Atria| fibrillation O Systemic em bolization
Mitral Stenosis Clinical Presentations ⚫ Asymptomatic ⚫ symptomatic Dyspnea, PND, Orthopnea Hemoptysis – usually pulmonary venous hypertension -rupture of alveolar capillaries. -pulmonary infarction. -ruptured of dilated bronchial veins. -chronic bronchitis. ⚫Signs of right-sided heart failure: in advanced disease ⚫Atrial fibrillation ⚫ Systemic embolization
Mitral stenosis Diagnosis Clinical and P2 (pulmonary hypertension Low-pitched mid diastolic rumble Opening snap(oS)开瓣音 and Loud s1 indicating pliable leaflets short os-s2 interval indicates severe Ms Mitral facies other auscultatory signs as per co-existing disease ECG P mitral: broad, notched P wave in ll and biphasic in V1 RVH and rightward axis if significant PHT
Mitral Stenosis Diagnosis • Clinical - and P2 (pulmonary hypertension) - Low-pitched mid diastolic rumble - Opening snap (OS)开瓣音and Loud S1 indicating pliable leaflets - short OS-S2 interval indicates severe MS -Mitral facies -other auscultatory signs as per co-existing disease ECG - P mitrale: broad, notched P wave in II and biphasic in V1 - RVH and rightward axis if significant PHT
LX Mitral stenosis HS Diagnosis LA CXR-LAA and LA enlargement SX increased upper lobe vascularity Kerley B and a lines aMS dilated Pa M calcification 148125 .ECHO: The GoLD STANDARD for diagnosis. Asses mitral valve mobility, gradient and mitral valve area
Mitral Stenosis Diagnosis • CXR - LAA and LA enlargement - increased upper lobe vascularity - Kerley B and A lines - dilated PA - MV calcification •ECHO: The GOLD STANDARD for diagnosis. Asses mitral valve mobility, gradient and mitral valve area