Mitral stenosis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Mitral stenosis}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Mitral_stenosis]]
{{CMG}}; {{AE}} {{CZ}};{{YK}}
{{CMG}}; {{AE}} {{CZ}};{{YK}}


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==Differentiating Mitral Stenosis from other Diseases==
==Differentiating Mitral Stenosis from other Diseases==
Mitral stenosis must be differentiated from the following:<ref name="pmid22379596">{{cite journal| author=Nassar PN, Hamdan RH| title=Cor Triatriatum Sinistrum: Classification and Imaging Modalities. | journal=Eur J Cardiovasc Med | year= 2011 | volume= 1 | issue= 3 | pages= 84-87 | pmid=22379596 | doi=10.5083/ejcm.20424884.21 | pmc=3286827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379596  }} </ref><ref name="pmid17170355">{{cite journal| author=Roudaut R, Serri K, Lafitte S| title=Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. | journal=Heart | year= 2007 | volume= 93 | issue= 1 | pages= 137-42 | pmid=17170355 | doi=10.1136/hrt.2005.071183 | pmc=1861363 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17170355  }} </ref><ref name="pmid19604402">{{cite journal| author=Apostolakis EE, Baikoussis NG| title=Methods of estimation of mitral valve regurgitation for the cardiac surgeon. | journal=J Cardiothorac Surg | year= 2009 | volume= 4 | issue=  | pages= 34 | pmid=19604402 | doi=10.1186/1749-8090-4-34 | pmc=2723095 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19604402  }} </ref><ref name="pmid3805524">{{cite journal| author=Alboliras ET, Edwards WD, Driscoll DJ, Seward JB| title=Cor triatriatum dexter: two-dimensional echocardiographic diagnosis. | journal=J Am Coll Cardiol | year= 1987 | volume= 9 | issue= 2 | pages= 334-7 | pmid=3805524 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3805524  }} </ref><ref name="pmid4412638">{{cite journal| author=Gibson DG, Honey M, Lennox SC| title=Cor triatriatum. Diagnosis by echocardiography. | journal=Br Heart J | year= 1974 | volume= 36 | issue= 8 | pages= 835-8 | pmid=4412638 | doi= | pmc=458901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4412638  }} </ref><ref name=radiopedia>Cor triatrium https://radiopaedia.org/articles/cor-triatriatum (2016) Accessed on November 29, 2016 </ref><ref name="pmid17258606">{{cite journal| author=Sosland RP, Vacek JL, Gorton ME| title=Congenital mitral stenosis: a rare presentation and novel approach to management. | journal=J Thorac Cardiovasc Surg | year= 2007 | volume= 133 | issue= 2 | pages= 572-3 | pmid=17258606 | doi=10.1016/j.jtcvs.2006.10.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17258606  }} </ref><ref name="pmid685838">{{cite journal| author=Driscoll DJ, Gutgesell HP, McNamara DG| title=Echocardiographic features of congenital mitral stenosis. | journal=Am J Cardiol | year= 1978 | volume= 42 | issue= 2 | pages= 259-66 | pmid=685838 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=685838  }} </ref>
Mitral stenosis must be differentiated from the following:<ref name="pmid22379596">{{cite journal| author=Nassar PN, Hamdan RH| title=Cor Triatriatum Sinistrum: Classification and Imaging Modalities. | journal=Eur J Cardiovasc Med | year= 2011 | volume= 1 | issue= 3 | pages= 84-87 | pmid=22379596 | doi=10.5083/ejcm.20424884.21 | pmc=3286827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379596  }} </ref><ref name="pmid17170355">{{cite journal| author=Roudaut R, Serri K, Lafitte S| title=Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. | journal=Heart | year= 2007 | volume= 93 | issue= 1 | pages= 137-42 | pmid=17170355 | doi=10.1136/hrt.2005.071183 | pmc=1861363 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17170355  }} </ref><ref name="pmid19604402">{{cite journal| author=Apostolakis EE, Baikoussis NG| title=Methods of estimation of mitral valve regurgitation for the cardiac surgeon. | journal=J Cardiothorac Surg | year= 2009 | volume= 4 | issue=  | pages= 34 | pmid=19604402 | doi=10.1186/1749-8090-4-34 | pmc=2723095 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19604402  }} </ref><ref name="pmid3805524">{{cite journal| author=Alboliras ET, Edwards WD, Driscoll DJ, Seward JB| title=Cor triatriatum dexter: two-dimensional echocardiographic diagnosis. | journal=J Am Coll Cardiol | year= 1987 | volume= 9 | issue= 2 | pages= 334-7 | pmid=3805524 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3805524  }} </ref><ref name="pmid4412638">{{cite journal| author=Gibson DG, Honey M, Lennox SC| title=Cor triatriatum. Diagnosis by echocardiography. | journal=Br Heart J | year= 1974 | volume= 36 | issue= 8 | pages= 835-8 | pmid=4412638 | doi= | pmc=458901 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4412638  }} </ref><ref name=radiopedia>Cor triatrium https://radiopaedia.org/articles/cor-triatriatum (2016) Accessed on November 29, 2016 </ref><ref name="pmid17258606">{{cite journal| author=Sosland RP, Vacek JL, Gorton ME| title=Congenital mitral stenosis: a rare presentation and novel approach to management. | journal=J Thorac Cardiovasc Surg | year= 2007 | volume= 133 | issue= 2 | pages= 572-3 | pmid=17258606 | doi=10.1016/j.jtcvs.2006.10.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17258606  }} </ref><ref name="pmid685838">{{cite journal| author=Driscoll DJ, Gutgesell HP, McNamara DG| title=Echocardiographic features of congenital mitral stenosis. | journal=Am J Cardiol | year= 1978 | volume= 42 | issue= 2 | pages= 259-66 | pmid=685838 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=685838 }} </ref><ref name="pmid24062899">{{cite journal| author=Bonou M, Lampropoulos K, Barbetseas J| title=Prosthetic heart valve obstruction: thrombolysis or surgical treatment? | journal=Eur Heart J Acute Cardiovasc Care | year= 2012 | volume= 1 | issue= 2 | pages= 122-7 | pmid=24062899 | doi=10.1177/2048872612451169 | pmc=3760527 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24062899  }} </ref><ref name="pmid20435842">{{cite journal| author=Maganti K, Rigolin VH, Sarano ME, Bonow RO| title=Valvular heart disease: diagnosis and management. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 5 | pages= 483-500 | pmid=20435842 | doi=10.4065/mcp.2009.0706 | pmc=2861980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20435842  }} </ref><ref name="pmid13315850">{{cite journal| author=DEXTER L| title=Atrial septal defect. | journal=Br Heart J | year= 1956 | volume= 18 | issue= 2 | pages= 209-25 | pmid=13315850 | doi= | pmc=479579 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13315850  }} </ref><ref name="pmid17030704">{{cite journal| author=Webb G, Gatzoulis MA| title=Atrial septal defects in the adult: recent progress and overview. | journal=Circulation | year= 2006 | volume= 114 | issue= 15 | pages= 1645-53 | pmid=17030704 | doi=10.1161/CIRCULATIONAHA.105.592055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17030704  }} </ref><ref name="pmid24725467">{{cite journal| author=Geva T, Martins JD, Wald RM| title=Atrial septal defects. | journal=Lancet | year= 2014 | volume= 383 | issue= 9932 | pages= 1921-32 | pmid=24725467 | doi=10.1016/S0140-6736(13)62145-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24725467  }} </ref><ref name="pmid16392241">{{cite journal| author=Demir M, Akpinar O, Acarturk E| title=Atrial myxoma: an unusual cause of myocardial infarction. | journal=Tex Heart Inst J | year= 2005 | volume= 32 | issue= 3 | pages= 445-7 | pmid=16392241 | doi= | pmc=1336732 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16392241  }} </ref><ref name="pmid8407260">{{cite journal| author=MacGowan SW, Sidhu P, Aherne T, Luke D, Wood AE, Neligan MC et al.| title=Atrial myxoma: national incidence, diagnosis and surgical management. | journal=Ir J Med Sci | year= 1993 | volume= 162 | issue= 6 | pages= 223-6 | pmid=8407260 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8407260  }} </ref><ref name=Obstruction>Circulation http://circ.ahajournals.org/content/119/7/1034 (2016) Accessed on December 7, 2016</ref><ref name="pmid16242436">{{cite journal| author=Alphonso N, Nørgaard MA, Newcomb A, d'Udekem Y, Brizard CP, Cochrane A| title=Cor triatriatum: presentation, diagnosis and long-term surgical results. | journal=Ann Thorac Surg | year= 2005 | volume= 80 | issue= 5 | pages= 1666-71 | pmid=16242436 | doi=10.1016/j.athoracsur.2005.04.055 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16242436  }} </ref><ref name=cortriatriatum>circulation http://circ.ahajournals.org/content/36/1/101 (1967) Accessed on 7 December, 2016</ref><ref name="pmid8181134">{{cite journal| author=Moore P, Adatia I, Spevak PJ, Keane JF, Perry SB, Castaneda AR et al.| title=Severe congenital mitral stenosis in infants. | journal=Circulation | year= 1994 | volume= 89 | issue= 5 | pages= 2099-106 | pmid=8181134 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8181134  }} </ref><ref name="pmid7815793">{{cite journal| author=Uva MS, Galletti L, Gayet FL, Piot D, Serraf A, Bruniaux J et al.| title=Surgery for congenital mitral valve disease in the first year of life. | journal=J Thorac Cardiovasc Surg | year= 1995 | volume= 109 | issue= 1 | pages= 164-74; discussion 174-6 | pmid=7815793 | doi=10.1016/S0022-5223(95)70432-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7815793  }} </ref><ref name="pmid7503011">{{cite journal| author=Banerjee A, Kohl T, Silverman NH| title=Echocardiographic evaluation of congenital mitral valve anomalies in children. | journal=Am J Cardiol | year= 1995 | volume= 76 | issue= 17 | pages= 1284-91 | pmid=7503011 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7503011  }} </ref><ref name="pmid3711511">{{cite journal| author=Sullivan ID, Robinson PJ, de Leval M, Graham TP| title=Membranous supravalvular mitral stenosis: a treatable form of congenital heart disease. | journal=J Am Coll Cardiol | year= 1986 | volume= 8 | issue= 1 | pages= 159-64 | pmid=3711511 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3711511  }} </ref><ref name="pmid22030961">{{cite journal| author=Subramaniam V, Herle A, Mohammed N, Thahir M| title=Ortner's syndrome: case series and literature review. | journal=Braz J Otorhinolaryngol | year= 2011 | volume= 77 | issue= 5 | pages= 559-62 | pmid=22030961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22030961 }} </ref>
{| class="wikitable"
{| class="wikitable"
! rowspan="2" |Diseases
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diseases
! rowspan="2" |History  
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |History  
! rowspan="2" |Symptoms
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! rowspan="2" |Physical Examination
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical Examination
! rowspan="2" |Murmur
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Murmur
! colspan="4" |Diagnosis
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnosis
! rowspan="2" |Other Findings
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other Findings
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
!ECG
! align="center" style="background:#4479BA; color: #FFFFFF;" + |ECG
!CXR
! align="center" style="background:#4479BA; color: #FFFFFF;" + |CXR
!Echocardiogram
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Echocardiogram
!Cardiac Catheterization
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cardiac Catheterization
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Stenosis
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Stenosis]]
| style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Age ( Mitral annular calcification in older patients)
* Age ( Mitral annular calcification in older patients)


* Rheumatic fever
* [[Rheumatic fever]]


* Endocarditis
* [[Endocarditis]]


|
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Dyspnea on exertion
* [[Dyspnea on exertion]]


* Paroxysmal nocturnal dyspnea
* [[Paroxysmal nocturnal dyspnea]]


* Orthopnea
* [[Orthopnea]]


* New onset atrial fibrillation
* New onset [[atrial fibrillation]]


| style="background: #F5F5F5; padding: 5px;" |
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Mitral facies
* Mitral facies


* Heart murmur
* Heart murmur


* Jugular vein distension
* [[JVD|Jugular vein distension]]


* Apical impulse displaced laterally or not palpable   
* Apical impulse displaced laterally or not palpable   
Line 51: Line 51:


* Signs of heart failure in severe cases
* Signs of heart failure in severe cases
| style="background: #F5F5F5; padding: 5px;" |
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Diastolic murmur
* Diastolic murmur


* Low pitched
* Low pitched


* Opening snap followed by decrescendo-crescendo rumbling murmur  
* Opening snap   followed by decrescendo-crescendo rumbling murmur  


* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position   
* Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position   


* Intensity increases after a valsalva maneuver, after exercise and after increased after load (eg., squatting, isometric hand grip)   
* Intensity increases after a [[valsalva maneuver]], after exercise and after increased after load (eg., squatting, isometric hand grip)   
| style="background: #F5F5F5; padding: 5px;" |
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* P mitrale
* [[P mitrale]]
* Atrial  fibrillation: No P waves and irregularly irregular rhythm
* [[Atrial  fibrillation]]: No P waves and irregularly irregular rhythm


* Right axis deviation
* [[Right axis deviation]]


* Right ventricular hyppertropy: Dominant R wave in V1 and V2
* Right ventricular hypertropy: Dominant R wave in V1 and V2
| style="background: #F5F5F5; padding: 5px;" |
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]
* Straightening of the left border of the heart suggestive of enlargement of the [[left atrium]]


Line 75: Line 75:
* Prominent left atrial appendage
* Prominent left atrial appendage


* Splaying of subcarinal angle (>120 degrees)
* Splaying of [[carina|subcarinal angle]] (>120 degrees)


* Calcification of mitral valve
* Calcification of [[mitral valve]]


* Kerley B lines   
* [[Kerley B lines]]  


|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Reduced valve leaflet mobility
* Reduced valve leaflet mobility


Line 90: Line 90:
* Valve thickening   
* Valve thickening   
* Enlargement of left atrium   
* Enlargement of left atrium   
|style="background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Right heart catheterization:'''
* Pulmonary capillary wedge pressure (left atrial pressure)  
* [[Pulmonary capillary wedge pressure]] (left atrial pressure)  
'''Left heart catheterization:'''
'''Left heart catheterization:'''
* Pressures in left ventricle
* Pressures in left ventricle
Line 97: Line 97:
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)
* Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)


|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Heamoptysis (heart failure)
* [[Hemoptysis]] ([[heart failure]])


* Ortner's syndrome
* [[Ortner's syndrome]]
|-
|-
| colspan="10" |
| colspan="10" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Regurgitation
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* CAD
* [[CAD]]


* MI
* [[MI]]


* Rheumatic fever
* [[Rheumatic fever]]


* Endocarditis
* [[Endocarditis]]


* Mitral valve prolapse
* [[Mitral valve prolapse]]


* Cardiomyopathy
* [[Cardiomyopathy]]


* Radiation therapy
* [[Radiation therapy]]


* Trauma
* Trauma


|
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Palpitations
* [[Palpitations]]


* Symptoms of heart failure in severe cases
* Symptoms of heart failure in severe cases
|style="background: #F5F5F5; padding: 5px;" |'''Palpation'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Palpation'''
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation
* Brisk carotid upstroke and hyperdymanic carotid impulse on palpation


Line 135: Line 135:
* Murmur
* Murmur


|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Holosystolic murmur
* [[Holosystolic murmur]]


* High pitched, blowing
* High pitched, blowing
Line 142: Line 142:
* Radiates to axilla
* Radiates to axilla


* Best heard with the diaphragm of the stethoscope at apex in left lateral decubitus position
* Best heard with the diaphragm of the stethoscope at apex in left lateral [[decubitus]] position


* Intensity increases with hand grip or squatting  
* Intensity increases with hand grip or squatting  


* Decrease in intensity on standing or valsalva maneuver  
* Decrease in intensity on standing or [[valsalva maneuver]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* P mitrale in lead II
* [[P mitrale]] in lead II
* Increased QRS voltage
* Increased QRS voltage
* Right axis deviation
* [[Right axis deviation]]
* Atrial fibrillation
* [[Atrial fibrillation]]
|style="background: #F5F5F5; padding: 5px;" |'''Acute MR'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Acute MR'''
* Kerley B lines
* [[Kerley B lines]]
* No enlargement of cardiac silhouette
* No enlargement of cardiac silhouette
'''Chronic MR'''
'''Chronic MR'''
Line 161: Line 161:
* Calcification of mitral annulus
* Calcification of mitral annulus
* Double right heart border
* Double right heart border
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Enlargement of left atrium and ventricle
* Enlargement of left atrium and ventricle
* Identify valve abnormality
* Identify valve abnormality
* Valve calcification
* Valve calcification
* Severity of regurgitation
* Severity of regurgitation
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Grading of MR is done with left ventriculography
* Grading of MR is done with left ventriculography
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Decompensated and acute MR may lead to heart failure
* Decompensated and acute MR may lead to [[heart failure]]
|-
|-
| colspan="10" |
| colspan="10" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Atrial Septal Defect
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial septal defect]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Frequent respiratory or lung infections
* Frequent respiratory or lung infections
* Dyspnea
* [[Dyspnea]]
* Tiring when feeding (Infants)
* Tiring when feeding (Infants)
* Shortness of breath on exertion
* Shortness of breath on exertion
* Palpitations
* [[Palpitations]]
* Edema of feet
* Swelling of feet
|
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Shortness of breath
* [[Shortness of breath]]
* Fatigue
* [[Fatigue]]
* Failure to thrive
* [[Failure to thrive]]
* Swelling of feet and abdomen (Right heart failure)
* Swelling of feet and abdomen ([[Right heart failure]])
* Palpitations
* [[Palpitations]]
* Respiratory infections
* Respiratory infections
|style="background: #F5F5F5; padding: 5px;" |'''Inspection'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''
* Precordial bulge
* Precordial bulge
* Precordial lift
* Precordial lift
Line 197: Line 197:
'''Auscultation'''
'''Auscultation'''
* Murmur
* Murmur
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Midsystolic (ejection systolic) murmur
* Midsystolic (ejection systolic) murmur


Line 203: Line 203:


* Upper left sternal border
* Upper left sternal border
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Normal  
* Normal  
* Prolonged PR interval
* Prolonged PR interval
* Right bundle branch block
* [[Right bundle branch block]]
* ECG findings varies according to the underlying type of ASD
* ECG findings varies according to the underlying type of ASD
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
*Increased pulmonary markings
*Increased pulmonary markings
*Cardiomegaly
*[[Cardiomegaly]]
*Triangular appearance of heart
*Triangular appearance of heart
*Schimitar sign
*Schimitar sign
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Gold standard test for diagnosis of atrial septal defect  (for more information click [[Atrial septal defect echocardiography]])
* Gold standard test for diagnosis of atrial septal defect  (for more information click [[Atrial septal defect echocardiography]])
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Defect size
* Defect size
* Pulmonary venous return
* Pulmonary venous return
* Pulmonary vascular resistance
* [[Pulmonary vascular resistance]]
* Pulmonary artery hypertension
* [[Pulmonary artery hypertension]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Asymptomatic until later part of their life
* Asymptomatic until later part of their life
* May be associated with migraine with aura
* May be associated with [[migraine with aura]]
|-
|-
| colspan="10" |
| colspan="10" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Left Atrial Myxoma
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Atrial myxoma|Left Atrial Myxoma]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Dyspnea
* [[Dyspnea]]
* Orthopnea
* [[Orthopnea]]
* Pulmonary edema
* [[Pulmonary edema]]
* Hyperpigmentation of skin and endocrine activity
* Hyperpigmentation of skin and endocrine activity
* Cerebral embolism
* Cerebral [[embolism]]
|
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Symptoms may mimic mitral stenosis
* Symptoms may mimic mitral stenosis
|style="background: #F5F5F5; padding: 5px;" |'''Skin'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Skin'''
* Signs of an embolic phenomenon
* Signs of an embolic phenomenon
* Raynaud's phenomenon
* [[Raynaud's phenomenon]]
* Swelling
* Swelling
* Clubbing
* Clubbing
Line 244: Line 244:


* Heart: Characteristic "tumor plop"  
* Heart: Characteristic "tumor plop"  
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Early diastolic sound as "tumor plop"
* Early diastolic sound as "tumor plop"


* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve   
* Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve   
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Often normal
* Often normal
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Often normal
* Often normal
'''Rare findings:'''
'''Rare findings:'''
* cardiomegaly
* [[cardiomegaly]]
* Left atrial enlargement
* Left atrial enlargement
* tumor calcification etc.,
* tumor calcification etc.,
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Initial and most useful diagnostic study
* Initial and most useful diagnostic study
* For more information click [[Myxoma echocardiography or ultrasound]]
* For more information click [[Myxoma echocardiography or ultrasound]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Useful to detect vascular supply of the tumor by the coronary arteries  
* Useful to detect vascular supply of the tumor by the coronary arteries  
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Associated with Carney complex (genetic predisposition)
* Associated with Carney complex (genetic predisposition)
|-
|-
| colspan="10" |
| colspan="10" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Prosthetic Valve Obstruction
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|
* History of valve replacement
|style="background: #F5F5F5; padding: 5px;" |
* Systemic embolism
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Shortness of breath
* Fatigue
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Ausculation'''
 
Muffling of murmur
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Muffling or disappearance of prosthetic sounds
* Muffling or disappearance of prosthetic sounds


* Appearance of new regurgitant or obstructive murmur  
* Appearance of new regurgitant or obstructive murmur  
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
* Degree of stenosis
|style="background: #F5F5F5; padding: 5px;" |
* Assess thrombus size and location
* Differentiate between thrombus, [[pannus]] and vegetations
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:
* Thrombus
* Pannus formation
|-
|-
| colspan="10" |
| colspan="10" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Cor Triatriatum
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Dyspnea on exertion  
* Dyspnea on exertion  
* Recent onset of congestive heart failure
* Recent onset of [[congestive heart failure]]
|
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Dsypnea on exertion
* Dsypnea on exertion
* Orthopnea
* Orthopnea
Line 292: Line 303:
* Palpitations
* Palpitations
* Growth failure
* Growth failure
|style="background: #F5F5F5; padding: 5px;" |'''Auscultation'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''
* Murmur
* Murmur
'''Other findings'''
'''Other findings'''
* Signs of heart failure
* Signs of heart failure
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Diastolic murmur with loud P2
* Diastolic murmur with loud P2


* No opening snap or a loud S1
* No opening snap or a loud S1
|style="background: #F5F5F5; padding: 5px;" |Non specific but may have
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Non specific but may have
* Right axis deviation
* [[Right axis deviation]]
* Right atrial enlargement
* Right atrial enlargement
* Right ventricular hypertrophy
* [[Right ventricular hypertrophy]]
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Normal cardiac silhouette
* Normal cardiac silhouette
* Hemodynamic changes similar to mitral stenosis (non specific findings)
* Hemodynamic changes similar to mitral stenosis (non specific findings)
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Direct visualization of membrane through the atrium
* Direct visualization of membrane through the atrium
* +/- visualization of accessory chamber
* +/- visualization of accessory chamber
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Normal left ventricular hemodynamic profile with a trans atrial gradient
* Normal left ventricular hemodynamic profile with a trans atrial gradient
|style="background: #F5F5F5; padding: 5px;" |Types
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Types
* Cor triatrium sinistrum
* Cor triatriatum sinistrum
* Cor triatrium dextrum
* Cor triatriatum dextrum
|-
|-
| colspan="10" |
| colspan="10" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Congenital Mitral Stenosis
| style="background: #F5F5F5; padding: 5px;" |
| style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Respiratory distress shortly after birth
* Respiratory distress shortly after birth
* Recurrent severe pulmonary infections
* Recurrent severe pulmonary infections
* Other associated congenital cardiovascular anamolies
* Other associated congenital cardiovascular anamolies
* Atrial fibrillation
* [[Atrial fibrillation]]
|
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |


'''Infants:'''
'''Infants:'''
* Exhaustion and sweating on feeding
* Exhaustion and sweating on feeding
* Rapid breathing
* Rapid breathing
* Failure to thrive
* [[Failure to thrive]]
* Pulmonary infections  
* Pulmonary infections  
* Chronic cough
* Chronic cough
Line 338: Line 349:
* Peripheral edema
* Peripheral edema
* Fatigue
* Fatigue
|style="background: #F5F5F5; padding: 5px;" |'''Auscultation'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation'''
* Murmur
* Murmur
'''Other findings'''
'''Other findings'''
* Signs of heart failure
* Signs of heart failure
|style="background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Mild-Moderate'''
* Loud S1
* Loud S1


Line 357: Line 368:
* Early diastolic murmur of pulmonic valve regurgitation  
* Early diastolic murmur of pulmonic valve regurgitation  


|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
*Sharp P waves in leads I and II
*Sharp P waves in leads I and II
*Inversion of P wave in lead III
*Inversion of P wave in lead III
*Marked Q waves in leads II and III
*Marked Q waves in leads II and III
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Left atrial dilation
* Left atrial dilation
* Moderate enlargement of right heart
* Moderate enlargement of right heart
* Pulmonary venous congestion
* Pulmonary venous congestion
* Esophageal compression
* Esophageal compression
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Reduced valve leaflet mobility
* Reduced valve leaflet mobility
* Left atrial size
* Left atrial size
* Severity of mitral stenosis
* Severity of mitral stenosis
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Very rare condition
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Very rare condition
|-
|-
| colspan="10" |
| colspan="10" |
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Supravalvular Ring Mitral Stenosis
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Other associated congenital heart defects
* Other associated congenital heart defects
*  
* Fatigue
|
* Frequent respiratory infections
|style="background: #F5F5F5; padding: 5px;" |
* Failure to thrive
|style="background: #F5F5F5; padding: 5px;" |
* Poor feeding
* Precocious congestive heart failure
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Shortness of breath
 
* Tachypnea
* Dyspnea
* Nocturnal cough
* Heamoptysis
* [[Syncope]]
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''
 
Lungs: Fine, crepitant rales and rhonchi or wheezes may be present
 
Heart: Murmur
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* An apical mid diastolic murmur with presystolic accentuation
* An apical mid diastolic murmur with presystolic accentuation


* No opening snap
* No opening snap


* The murmur is more prominent if associated with VSD or PDA
* The murmur is more prominent if associated with [[VSD]] or [[PDA]]


|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Left atrial and ventricular enlargement
* Left atrial and ventricular enlargement
* Alveolar edema  
* Alveolar edema  
|style="background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Supramitral ring''':
* Associated with normal mitral valve apparatus
* Associated with normal mitral valve apparatus
'''Intramitral ring:'''
'''Intramitral ring:'''
Line 400: Line 426:
* Dominant papillary muscle
* Dominant papillary muscle
* Hypoplastic mitral annulus
* Hypoplastic mitral annulus
|style="background: #F5F5F5; padding: 5px;" |
(Difficult to visualize membrane <1mm in size)
|style="background: #F5F5F5; padding: 5px;" |'''Types'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Persistently elevated pulmonary venous pressures
* Increased pulmonary artery pressure
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Types'''
* Supramitral
* Supramitral
* Intramitral
* Intramitral

Latest revision as of 20:05, 28 February 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2];Yamuna Kondapally, M.B.B.S[3]

Overview

The possible causes, and other conditions that may present similarly, should be evaluated for when there is suspicion of mitral stenosis.

Differentiating Mitral Stenosis from other Diseases

Mitral stenosis must be differentiated from the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]

Diseases History Symptoms Physical Examination Murmur Diagnosis Other Findings
ECG CXR Echocardiogram Cardiac Catheterization
Mitral Stenosis
  • Age ( Mitral annular calcification in older patients)
  • Mitral facies
  • Heart murmur
  • Apical impulse displaced laterally or not palpable
  • Diastolic thrill at the apex
  • Signs of heart failure in severe cases
  • Diastolic murmur
  • Low pitched
  • Opening snap followed by decrescendo-crescendo rumbling murmur
  • Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position
  • Intensity increases after a valsalva maneuver, after exercise and after increased after load (eg., squatting, isometric hand grip)
  • Right ventricular hypertropy: Dominant R wave in V1 and V2
  • Straightening of the left border of the heart suggestive of enlargement of the left atrium
  • Double right heart border (Enlarged left atrium and normal right atrium)
  • Prominent left atrial appendage
  • Reduced valve leaflet mobility
  • Valve calcification
  • Doming of mitral valve
  • Valve thickening
  • Enlargement of left atrium
Right heart catheterization:

Left heart catheterization:

  • Pressures in left ventricle
  • Determines the gradient between the left and right atrium during ventricular diastole (marker of the severity of mitral stenosis)
Mitral Regurgitation
  • Trauma
  • Symptoms of heart failure in severe cases
Palpation
  • Brisk carotid upstroke and hyperdymanic carotid impulse on palpation
  • Apical impulse is displaced to left
  • S3 and a palpable thrill

Auscultation

  • Murmur
  • High pitched, blowing
  • Radiates to axilla
  • Best heard with the diaphragm of the stethoscope at apex in left lateral decubitus position
  • Intensity increases with hand grip or squatting
Acute MR

Chronic MR

  • Enlarged cardiac silhouette
  • Straightening of left heart border
  • Splaying of subcarinal angle
  • Calcification of mitral annulus
  • Double right heart border
  • Enlargement of left atrium and ventricle
  • Identify valve abnormality
  • Valve calcification
  • Severity of regurgitation
  • Grading of MR is done with left ventriculography
Atrial septal defect
  • Frequent respiratory or lung infections
  • Dyspnea
  • Tiring when feeding (Infants)
  • Shortness of breath on exertion
  • Palpitations
  • Swelling of feet
Inspection
  • Precordial bulge
  • Precordial lift

Palpation

  • Right ventricular impulse
  • Pulmonary artery pulsations
  • Thrill

Auscultation

  • Murmur
  • Midsystolic (ejection systolic) murmur
  • Widely split, fixed S2
  • Upper left sternal border
  • Increased pulmonary markings
  • Cardiomegaly
  • Triangular appearance of heart
  • Schimitar sign
Left Atrial Myxoma
  • Symptoms may mimic mitral stenosis
Skin

Auscultation:

  • Lung: Fine crepitations
  • Heart: Characteristic "tumor plop"
  • Early diastolic sound as "tumor plop"
  • Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve
  • Often normal
  • Often normal

Rare findings:

  • cardiomegaly
  • Left atrial enlargement
  • tumor calcification etc.,
  • Useful to detect vascular supply of the tumor by the coronary arteries
  • Associated with Carney complex (genetic predisposition)
Prosthetic Valve Obstruction
  • History of valve replacement
  • Systemic embolism
  • Shortness of breath
  • Fatigue
Ausculation

Muffling of murmur

  • Muffling or disappearance of prosthetic sounds
  • Appearance of new regurgitant or obstructive murmur
  • Degree of stenosis
  • Assess thrombus size and location
  • Differentiate between thrombus, pannus and vegetations
Causes:
  • Thrombus
  • Pannus formation
Cor Triatriatum
  • Dsypnea on exertion
  • Orthopnea
  • Tachypnea
  • Palpitations
  • Growth failure
Auscultation
  • Murmur

Other findings

  • Signs of heart failure
  • Diastolic murmur with loud P2
  • No opening snap or a loud S1
Non specific but may have
  • Normal cardiac silhouette
  • Hemodynamic changes similar to mitral stenosis (non specific findings)
  • Direct visualization of membrane through the atrium
  • +/- visualization of accessory chamber
  • Normal left ventricular hemodynamic profile with a trans atrial gradient
Types
  • Cor triatriatum sinistrum
  • Cor triatriatum dextrum
Congenital Mitral Stenosis
  • Respiratory distress shortly after birth
  • Recurrent severe pulmonary infections
  • Other associated congenital cardiovascular anamolies
  • Atrial fibrillation

Infants:

  • Exhaustion and sweating on feeding
  • Rapid breathing
  • Failure to thrive
  • Pulmonary infections
  • Chronic cough

Older patients:

  • Dyspnea
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Peripheral edema
  • Fatigue
Auscultation
  • Murmur

Other findings

  • Signs of heart failure
Mild-Moderate
  • Loud S1
  • Loud P2
  • Low frequency diastolic murmur best heard at the apex

Severe

  • Soft S1
  • Loud pulmonic component of S2 with minimal respiratory splitting of S2
  • Holodiastolic murmur with presystolic accentuation best heard at the apex
  • Early diastolic murmur of pulmonic valve regurgitation
  • Sharp P waves in leads I and II
  • Inversion of P wave in lead III
  • Marked Q waves in leads II and III
  • Left atrial dilation
  • Moderate enlargement of right heart
  • Pulmonary venous congestion
  • Esophageal compression
  • Reduced valve leaflet mobility
  • Left atrial size
  • Severity of mitral stenosis
Very rare condition
Supravalvular Ring Mitral Stenosis
  • Other associated congenital heart defects
  • Fatigue
  • Frequent respiratory infections
  • Failure to thrive
  • Poor feeding
  • Precocious congestive heart failure
  • Shortness of breath
  • Tachypnea
  • Dyspnea
  • Nocturnal cough
  • Heamoptysis
  • Syncope
Auscultation:

Lungs: Fine, crepitant rales and rhonchi or wheezes may be present

Heart: Murmur

  • An apical mid diastolic murmur with presystolic accentuation
  • No opening snap
  • The murmur is more prominent if associated with VSD or PDA
  • Left atrial and ventricular enlargement
  • Alveolar edema
Supramitral ring:
  • Associated with normal mitral valve apparatus

Intramitral ring:

  • Hypomobility of the posterior leaflet
  • Reduced interpapillary muscle distance
  • Reduced chordal length
  • Dominant papillary muscle
  • Hypoplastic mitral annulus

(Difficult to visualize membrane <1mm in size)

  • Persistently elevated pulmonary venous pressures
  • Increased pulmonary artery pressure
Types
  • Supramitral
  • Intramitral

It is attached between the opening of the atrial appendage and the mitral annulus which helps in differentiating with Cor triatriatum sinister.

  • Intramitral type is associated with shone complex

References

  1. Nassar PN, Hamdan RH (2011). "Cor Triatriatum Sinistrum: Classification and Imaging Modalities". Eur J Cardiovasc Med. 1 (3): 84–87. doi:10.5083/ejcm.20424884.21. PMC 3286827. PMID 22379596.
  2. Roudaut R, Serri K, Lafitte S (2007). "Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations". Heart. 93 (1): 137–42. doi:10.1136/hrt.2005.071183. PMC 1861363. PMID 17170355.
  3. Apostolakis EE, Baikoussis NG (2009). "Methods of estimation of mitral valve regurgitation for the cardiac surgeon". J Cardiothorac Surg. 4: 34. doi:10.1186/1749-8090-4-34. PMC 2723095. PMID 19604402.
  4. Alboliras ET, Edwards WD, Driscoll DJ, Seward JB (1987). "Cor triatriatum dexter: two-dimensional echocardiographic diagnosis". J Am Coll Cardiol. 9 (2): 334–7. PMID 3805524.
  5. Gibson DG, Honey M, Lennox SC (1974). "Cor triatriatum. Diagnosis by echocardiography". Br Heart J. 36 (8): 835–8. PMC 458901. PMID 4412638.
  6. Cor triatrium https://radiopaedia.org/articles/cor-triatriatum (2016) Accessed on November 29, 2016
  7. Sosland RP, Vacek JL, Gorton ME (2007). "Congenital mitral stenosis: a rare presentation and novel approach to management". J Thorac Cardiovasc Surg. 133 (2): 572–3. doi:10.1016/j.jtcvs.2006.10.025. PMID 17258606.
  8. Driscoll DJ, Gutgesell HP, McNamara DG (1978). "Echocardiographic features of congenital mitral stenosis". Am J Cardiol. 42 (2): 259–66. PMID 685838.
  9. Bonou M, Lampropoulos K, Barbetseas J (2012). "Prosthetic heart valve obstruction: thrombolysis or surgical treatment?". Eur Heart J Acute Cardiovasc Care. 1 (2): 122–7. doi:10.1177/2048872612451169. PMC 3760527. PMID 24062899.
  10. Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010). "Valvular heart disease: diagnosis and management". Mayo Clin Proc. 85 (5): 483–500. doi:10.4065/mcp.2009.0706. PMC 2861980. PMID 20435842.
  11. DEXTER L (1956). "Atrial septal defect". Br Heart J. 18 (2): 209–25. PMC 479579. PMID 13315850.
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