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><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>
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]]
Line 65: Line 65:
* [[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 hypertropy: Dominant R wave in V1 and V2
* Right ventricular hypertropy: Dominant R wave in V1 and V2
Line 104: Line 104:
| colspan="10" |
| colspan="10" |
|-
|-
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Mitral Regurgitation
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Mitral Regurgitation]]
|style="vertical-align: top;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;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Palpitations
* [[Palpitations]]


* Symptoms of heart failure in severe cases
* Symptoms of heart failure in severe cases
Line 136: Line 136:


|style="vertical-align: top;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="vertical-align: top;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="vertical-align: top;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 169: Line 169:
* Grading of MR is done with left ventriculography
* Grading of MR is done with left ventriculography
|style="vertical-align: top;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="vertical-align: top;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="vertical-align: top;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;" |
|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="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Inspection'''
Line 206: Line 206:
* 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="vertical-align: top;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
Line 218: Line 218:
* Defect size
* Defect size
* Pulmonary venous return
* Pulmonary venous return
* Pulmonary vascular resistance
* [[Pulmonary vascular resistance]]
* Pulmonary artery hypertension
* [[Pulmonary artery hypertension]]
|style="vertical-align: top;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="vertical-align: top;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="vertical-align: top;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;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Symptoms may mimic mitral stenosis
* Symptoms may mimic mitral stenosis
|style="vertical-align: top;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 253: Line 253:
* Often normal
* Often normal
'''Rare findings:'''
'''Rare findings:'''
* cardiomegaly
* [[cardiomegaly]]
* Left atrial enlargement
* Left atrial enlargement
* tumor calcification etc.,
* tumor calcification etc.,
Line 285: Line 285:
* Degree of stenosis
* Degree of stenosis
* Assess thrombus size and location
* Assess thrombus size and location
* Differentiate between thrombus, pannus and vegetations
* Differentiate between thrombus, [[pannus]] and vegetations
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |Causes:
Line 293: Line 293:
| colspan="10" |
| colspan="10" |
|-
|-
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |Cor Triatriatum
|style="vertical-align: top;background: #DCDCDC; padding: 5px; text-align: center;" |[[Cor Triatriatum]]
|style="vertical-align: top;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;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Dsypnea on exertion
* Dsypnea on exertion
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* No opening snap or a loud S1
* No opening snap or a loud S1
|style="vertical-align: top;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="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |
* Normal cardiac silhouette
* Normal cardiac silhouette
Line 324: Line 324:
* Normal left ventricular hemodynamic profile with a trans atrial gradient
* Normal left ventricular hemodynamic profile with a trans atrial gradient
|style="vertical-align: top;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" |
Line 334: Line 334:
* 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;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |


Line 340: Line 340:
* 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 401: Line 401:
* Nocturnal cough
* Nocturnal cough
* Heamoptysis
* Heamoptysis
* Syncope
* [[Syncope]]
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |'''Auscultation:'''


Line 412: Line 412:
* 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="vertical-align: top;background: #F5F5F5; padding: 5px;" |
|style="vertical-align: top;background: #F5F5F5; padding: 5px;" |

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

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  20. Uva MS, Galletti L, Gayet FL, Piot D, Serraf A, Bruniaux J; et al. (1995). "Surgery for congenital mitral valve disease in the first year of life". J Thorac Cardiovasc Surg. 109 (1): 164–74, discussion 174-6. doi:10.1016/S0022-5223(95)70432-9. PMID 7815793.
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