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Medicine

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Cardiology

Question
3 out of 30
 

Which of the following is a feature of severe MS? (AIPG 2009)



A Length of murmur
B A2 – OS interval

C Both
D None

Ans. C

Both

Mitral Stenosis (Ref. Hari-18th ed., Pg-1929)

Causes: Rheumatic; congenital (Rare), mucopolysaccharidoses, endocardial fibroelastosis, malignant carcinoid prosthetic valve.

RHD is the most common cause of MS. Rest all causes are extremely rare

Pathophysiology –

Mitral stenosis –LA pressure increase à Pulm venous and pulm arterial wedge pressure increases (responsible for exertional dyspnea) à Pulmonary hypertension.

Extra Edge:

1. In normal adults, the area of the mitral valve orifice is 4–6 cm2.

2. In the presence of significant obstruction, blood can flow from the LA to the LV only if propelled by an abnormally elevated left atrioventricular pressure gradient, the hemodynamic hallmark of MS.

3. When the mitral valve opening is reduced to <1 cm2, often referred to as "severe" MS, a LA pressure of ~25 mmHg is required to maintain a normal cardiac output (CO).

4. The elevated pulmonary venous and pulmonary arterial (PA) wedge pressures reduce pulmonary compliance, contributing to exertional dyspnea. (Ref. Hari-18th ed., Pg- 1929)

Presentation: Dyspnoea Q on exertion (main symptom) fatigue; palpitations; chest pain Q; hemoptysis Q, Hoarseness of voice (Autner syndrome), dysphagia.

Signs: Malar flush Q; low-volume pulse Q; Af Q -Palpitations – Usually due to atrial arrhythmias.

On examination - Tapping apex beat, left parasternal heave (due to right ventricular hypertrophy)

On auscultation: loud S1Q; opening snap Q (pliable valve Q); rumbling mid-diastolic murmur Q. Loud P2, Graham Steell murmur Qmay occur.

Extra Edge: LVH & S3 are not feature of MS

Severity is indicated by

1. Longer the diastolic murmur

2. The closer the opening snap to A2.

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