Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Mitral Stenosis (MS) 993

MITRAL STENOSIS (MS)

JUDITH A. WISNESKI, MD

history & physical

■Most common – rheumatic heart disease (women 3–4×more com-

mon than men)

■Congenital

■Malignant carcinoid (rare)

History

■Symptoms of pulmonary congestion: DOE, orthopnea, PND

■Symptoms of right heart failure: peripheral edema, elevated JVP,

ascites (more severe)

■Hemoptysis – due to pulmonary hypertension (more severe)

■Hoarseness or dysphasia – due to enlarged left atrium (rare)

■Systemic emboli (common, especially with atrial fibrillation)

■Rapid atrial fibrillation poorly tolerated

Signs & Symptoms

■Diastolic rumble and possible diastolic thrill (best appreciated in left

lateral decubitus position)

■Opening Snap (OS)

■Normal PMI

■S1 intensity increased (mild MS)

■Soft S1 (more severe MS)

■P2 increased with right ventricular lift (more severe MS)

■S2-OS interval shorter with more severe MS (<0.10 sec=severe MS)

■S3 and S4 absent with significant MS

tests

■ECG

➣Left atrial enlargement

➣Right axis deviation

➣Right ventricular hypertrophy

➣Atrial fibrillation

■Chest X-Ray

➣Normal left ventricular size

➣Left atrial enlargement

➣Pulmonary arteries enlarged (pulmonary artery hypertension)