Mitral stenosis is a narrowing of the mitral valve opening that causes blood to back up in the lungs. It is usually caused by rheumatic fever which causes the mitral valve flaps to stick together. The main symptoms are shortness of breath, fatigue, and coughing. On examination, doctors may hear murmurs and find an enlarged heart and liver. Echocardiograms and chest x-rays can confirm the diagnosis by showing the narrowed valve opening and enlarged chambers. Treatment options include medications, balloon valvuloplasty to widen the valve, or open heart surgery to replace or repair the valve.

1. Mitral stenosisMitral stenosis

2. Mitral stenosisMitral stenosis
is anatomical defect of mitral valve
in which its cups adhere at their
commissures. Mitral orifice
stenosis low than 4 cm2
.

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6. Etiology:Etiology:
Rheumatic inflammation (fever);
Bacterial (inflectional) endocarditis;
Atherosclerosis in the elderly due to
calcification and fibrosis of the valve,
valve ring and chordae tendineae;
Congenital mitral stenosis.

7. Pathophysiology:Pathophysiology:
Serious haemodynamic consequences
develops only when the mitral valve orifice is
reduced from its normal size
( approximately 4 cm2
to about 1 cm2
).
In severe mitral stenosis, the orifice is
reduced to less than 1 sm long and 0,5 sm
across.

8. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
(HEMODYNAMICAL(HEMODYNAMICAL
DESORDERS)DESORDERS) AT THE END OF DIASTOLE,SYSTOLE LEFT
ATRIUM IS BEGINED.BLOOD FLOW IS
INJECTED to LEFT VENTRICULAR FROM
NARROWED(STENOSED) MITRAL ORIFICE
AND FORMED DIASTOLICUS
MURMUR.STENOSIS MITRAL ORIFICE IS
CAUSE OF THE INCREAS PRESSURE IN
LEFT ATRIUM.INCREAS PRESSURE IN LEFT
ATRIUM IS CAUSE OF THE INCREASE
EXERTIONE ON LA ( HIS HYPERTROPHY
,DILATATION) AND Kitaev,s REFLEX.

9. Pathophysiology(hemodinamicPathophysiology(hemodinamic
desorders)desorders)
Kitaev,s reflex(spasm arterias pulmonary
circulation) is the cause of increase
pressure in pulmonary arteria,increase
exertatione on RV,his hyperthrophy and
dilatation.
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10. Symptoms:Symptoms:
The major symptom of mitral stenosis is
shortness of breath. This occurs at first only
during tough exercise, but as time passes less
and less exertion is required to evoke it.
Eventually, orthopnoea develops and the
patient is liable to attacks of paroxysmal
dyspnoea and acute pulmonary edema.
Haemoptysis occurs in some 10-20% of patients
with mitral stenosis but is seldom severe.

11. Physical signs:Physical signs:
Mitral face: malar flush
bilateral cyanotic discolouration of
upper cheek due to arteriovenous
anastomoses and vascular stasis.
The arterial pulse is usually
in volume but may be small, and is
often irregular due to atrial
fibrillation.

12. The apex beat is usually in theThe apex beat is usually in the
normal place. Middiastolic andnormal place. Middiastolic and
presystolic thrills may bepresystolic thrills may be
present at or internal to thepresent at or internal to the
apex beat. The heart bordersapex beat. The heart borders
are deviated to the upper andare deviated to the upper and
to the right.to the right.

13. auscultatory features of mitralauscultatory features of mitral
stenosis.stenosis.
The first sound isThe first sound is
accentuated and the openingaccentuated and the opening
snap loud when the cusps aresnap loud when the cusps are
mobile.mobile.
The second sound isThe second sound is
often accentuated because ofoften accentuated because of
pulmonary hypertension.pulmonary hypertension.
The presystolic(diastolic)The presystolic(diastolic)
murmur is often and early sign.murmur is often and early sign.

14. The ECG:The ECG:
If sinus rhythm is present, there is
usually P- mitrale. Atrial fibrillation is
common; other atrial and ventricular
arrhythmias occur occasionally.
Evidence of right ventricular
hypertrophy develops in cases with
severe pulmonary hypertension.
This signs are S1
, R3
.

15. Radiological appearances:Radiological appearances:
The most characteristic radiological
feature of mitral stenosis is the selective
enlargement of the left atrium and right
ventricle. Pulmonary artery, right
ventricular and, occasionally, right atrial
enlargement may also be present when
there is pulmonary arterial hypertension.

16. Echocardiography:Echocardiography:
Dilatation LA and RV;
Stenosis of mitral valve orifice
– the rate transmitral
patological flow

19. Complications:Complications:
 Atrial fibrillation develops sooner or
later in most cases of mitral stenosis;
 Pulmonary embolism and infarctions
frequently occur;
 Systemic embolism is common and often
follows the onset of atrial fibrillation. In
most of cases cerebral embolism
develops. but can involve the mesenteric,
renal or other arteries;

20. The congested respiratory tract,
develops the attacks of acute
bronchitis and then chronic
bronchitis;
 Infective endocarditis is rare in pure
mitral stenosis but is common as a
complication of mixed mitral
stenosis and regurgitation;
Cardiac asthma;
Pulmonary edema.

21. Treatment:Treatment:
Diet №10
Regime freedom
Treatment of basis disease
Balloon valvotomy
Surgical treatment – mitral
commissurotomy