Mitral Stenosis

1. MITRAL STENOSIS
DR DHANESH KUMAR

2. • Mrs. Khushnuma
• 28/F
• Muslim
• Housewife
• Sahibabad(U.P)
• Lower middle class family

3. Symptoms
• Dyspnoea since 1 month
• Chest pain on exertion since 3 years

4. History of present illness
Chest pain
• Gradual
• Diffuse
• Non –progressive
• Non-radiating
• On and off
• NYHA-II
• Increases on exertion

5. Dyspnoea
• Sudden
• On mild exertion
• NYHA-III
• Progressive
• Associated with palpitation
• Not associated with orthopnoea /PND

6. • No history of syncope ,weakness of limb,
intermittent claudications, blurring of vision
,loss of weight, hemoptysis, frequent URTI’s,in
past.

7. Past history
• History of unconsiousness present 2 year back
last for about 1 min self reverted without any
neurological sequale.
• No history of HT/DM/ T.B/COPD in past.
• History of two LSCS opration present.
• History of penicillin prophylaxis present .

8. Family history
• History of CAD present in father undergone
CABG at age of 54 year.

9. Social and personal history
• Middle class family
• 2 live issues
• Started menses at age of 13 years regular,
normal cycle, normal flow
• Non-smoker ,non-alcoholic ,vegitarian

10. Drug history
• Taking penicillin prophylaxis since 2 years
• Taking Digoxin since past 6 month
• Taking Aspirin since past 6 month

11. General physical examination
• HR-90/min Irregularly irregular
• BP-130/70mmof Hg
• RR-20/min
• Temp-98.4 F
• SpO2-100% RA
Concious well oriented to time ,place and person .
No P/I/CY/CL/PE/LAP/JVP-NR
Well nourished BMI-27.7Kg/m2

12. Systemic examination
Inspection-Apex beat- 5th ICS just medial to mid -
clavicular line.
No visible pulsation in suprasternal notch and in
epigastrium
No scar mark on chest, supf. Varicosities
No visible chest defomity

13. Palpation
Palpation:
• Small volume pulse
• Tapping apex-palpable S1
• RV lift
• Palpable P2 in 2nd ICS
• No palpable thrill

14. Auscultation
Auscultation:
• Loud S1- as loud as S2 in aortic area
• P2 at mitral and aortic area
• Mid-Diastolic rumble, low pitched best heard
at the apex ,with the bell of stethoscope and
with patient in LL recumbent position.
Radiating to left axilla.
• OS –not audible

15.  First heart sound (S1) is accentuated and snapping
 Opening snap (OS) after aortic valve closure
 Low pitch diastolic rumble at the apex
 Pre-systolic accentuation (esp. if in sinus rhythm)
Mitral Stenosis: Physical Exam
S1 S2 OS S1

17. • LAE
• RVH
• Premature contractions
• Atrial flutter and/or fibrillation
–  freq. in pts with mod-severe MS for several years
– A fib develops in  30% to 40% of pts w/symptoms
Mitral Stenosis: EKG

18. X –RAY

19. ECHO