Mitral stenosis is a valvular heart disease characterized by the narrowing of the mitral valve orifice, often resulting from rheumatic fever, which can take decades to develop. Clinical features include dyspnea, cough, and signs of pulmonary edema, with diagnostic investigations such as echocardiography and electrocardiograms revealing atrial hypertrophy. Treatment options include medications, valvuloplasty, and mitral valve replacement, alongside a structured physiotherapy regimen for patients with operative conditions.

1. DR.SAMIR JADAV (PT)

2.  DEFINITION
 AETIOLOGY
 PATHOLOGY
 PATHOPHYSIOLOGY
 CLINICAL FEATURES
 INVESTIGATIONS
 TREATMENT
 PT ASSESSMENT
 PT MANAGEMENT

3.  Mitral stenosis is valvular heart disease characterized by
narrowing of orifice of mitral valve so that in this restriction of
blood flow from LA to LV during diastole.

4.  Rheumatic fever
- Usually severe mitral stenosis takes about 22 to 30
years to develop after the last known bout of
rheumatic fever.
 Calcium deposits
 Other causes
- congenital defect
- chest radiation (rare)
- autoimmune disease such as lupus.

5.  Rheumatic fever produces a widespread manifestation in in the
heart.
 It affects all 3 layers.
 Endocarditis produces ulceration of the endocardium along the
ages of valve leaflets where they normally appose in systole.
 Tiny nodules of fibrin and platelets accumulates and gradually progress
to fusion of leaflets at the commissures.
 The above mentioned nodules are called Ashchoff nodules.
 Gradually, the valve cups become more swollen and roughened.

6.  Later, fibrosis and calcification occurs.
 So valve leaflets become thickened, rigid and immobile.
 Calcified and functionless valve are seen.
 It restricts blood flow.
 Severity increases gradually over many years.

7.  According to the cross-sectional area of opening of mitral valve, can be
classified into four classes:-
Class Cross sectional area
reduced to
Severity of
symptoms
I 2.5 cm2 Mild asymptomatic
II 1.5 - 2 cm2 Moderate symptoms
III 1 - 1.5 cm2 Severe condition
IV Less than 1 cm2 Severe condition

8.  Three haemodynamic events occurs :
1) Increase in LA pressure
2) Increase in pulmonary vascular resistance
3) Decrease in cardiac output

9.  Symptoms :
oDysponea
oPulmonary oedema
oChronic cough
oOrthopnea
oCough with or without blood
oPeripheral oedema
oArterial embolism
oAngina pectoris
oRespiratory infections

10.  Physical examination :
o Patients are thin and frail with muscular wasting
o Dilated neck veins
o Rales
o Increased first heart sound
o Diastolic murmur
o Systolic murmur

11. 1) Echocardiography
2) Chest radiography
3)Electrocardiogram
- increased p-wave due to atrial hypertrophy
4) Cardiac catheterization

12. (A) Medication :
1)Anticoagulants :
- blood thinners
- to reduce the risk of blood clots.
2)Diuretics :
- to reduce fluid build-up through increased urine outflow.
3)Antyarrhythmics :
- to treat abnormal heart rhythms.

13. 4)Beta blockers : to slow HR.
(B) Valvotomy/Valvuloplasty :
- The mitral valve is corrected by balloon.
-Once, in the mitral valve, the Surgeon inflates the balloon to expand the
valve.
(C) Surgery :

14. - Mitral valve replacement :
- The valve prosthesis is placed.
- If the valve is so rigid or calcified that correction can not occur.
- Regular follow-up: at 1-2 yearly intervals because restenosis may occur.

15.  DEMOGRAPHIC DETAILS
 CHIEF COMPLAINTS
o Chest pain/discomfort
o Problem in breathing
o Cough at night
 HISTORY

16.  H/O PRESENT ILLNESS: Rheumatic fever in childhood.
 MEDICAL HISTORY : Any recurrent infections or systemic
illness.
 DRUG HISTORY : Medicines taken by patients
 FAMILY HISTORY : Any family member with disease.
 SOCIOECONOMIC HISTORY : Patient belongs to middleclass family.

17.  SUBJECTIVE ASSESSMENT
 DYSPNOEA : -Present
-Assess severity with NYHA scale.
 COUGH :Present at night
 HAEMOPTYSIS : present in class 3 & 4
 CHEST PAIN : Type - Angina pectoris
Site – Parasternal, also jaw, neck, shoulder and
forearm.

18.  OBJECTIVE ASSESSMENT
 Cyanosis : Type – Peripheral
 Body built
 Oedema : Pulmonary
 Breathing pattern : Normal

19.  ON EXAMINATION
 BP : Increased
 HR : Increased
 RR : Normal
 TEMPRATURE : Reduce
 ON PALPATION
TENDERNESS : Parasternal in left side. (RV hypertrophy)

20.  ON AUSCULTATION :
 Breath sounds : - Absent
- low pitched sound
 Heart sound : - Abnormal
- first sound is large

21.  INVESTIGATIONS
 Chest X-ray
 ECG : Abnormal ‘P’ wave.
 Cardiac catheterization
 Echocardiograph
 DIAGNOSIS

22.  Physiotherapy not done in class 1 and 2.
 Therapy is given when there is operative condition is there.
1) Pre-operative therapy :
 Relaxation is given
 Breathing exercise
 Stretching
 Strengthening exs. – peripheral and respiratory.

23. 2) Post-operative therapy :
 CARDIAC REHAB