Mitral stenosis

           Most common cause if Rheumatic  fever ,that causes -
                          Mitral lesion 50% 

                          Mitral lesion with aortic lesion 40%
                          Mitral lesion with tricuspid lesion 2%

                          Combination 3%

In older-Due to calcification

Why high evidence of mitral lesion in rheumatic fever?-Due to pressure difference/more work load

Mitral orifice

  
                       Normal-5cm sq.

                          Asymptomatic -until <2cm sq./symptomatic

                              Severe stenosis-1cm sq.

Mitral facies

Dusky malar discoloration due to Arteriovenous  anastomosis and vascular stasis

Investigation

ECG

                       P mitrale or atrial fibrillation

                       Right ventricular hypertrophy(Without AF): R >S or R=S with R8 axis deviation in V1–V3

Chest X-ray

                      Enlarged LA and appendage

                      Signs of pulmonary venous congestion

Echo

              Thickened immobile cusps

              Reduced valve area

              Reduced rate of diastolic filling of LV

              Enlarged LA

Doppler

                 Pressure gradient across mitral valve

                 Pulmonary artery pressure

                 Left ventricular function

Cardiac catheterisation

                               Coronary artery disease

                               Mitral stenosis and regurgitation

                               Pulmonary artery pressure

Management

                 Digoxin ,beta  blockers ,Ca antagonist  in atrial fibrillation

                 Diuretics

                 Antibiotics prophylaxis for infective endocarditis

                 Mitral balloon valvuloplasty and valve replacement

                 Close mitral commissurotomy(Curvy incision at mitral area)

Complication

                   Atrial fibrillatopn

                   Pulmonary edema

                   Thromboembolism    

                   Severe hemoptysis(Ruptured pulmonary/bronchial vein ,thromboembolism ,chest infection)

                   Pulmonary hemosclerosis

                   Right venrticular failure(When pulmonary hypertension)

          Never Left ventricular failure(Here occurs stenosis,so  no extra pressure on LV)