This presentation includes everything about the mitral stenosis which bpt students need to know. This presentation is made for learning purpose only.

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