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(MS)
INTRODUCTION
MS ( obstruction to LA LV flow)
PH (protective phenomenon)
RVH RVF
Pulmonary HTN in MS
Due to
-pH RV O2 demand
-IHD ( CAD)
-acute Pul.infarction ( emboli)
Clinical signs
Inspection
Mitral facies cyanotic patch on
cheek( CO)
Low volume pulse ( CO)
Peripheral cyanosis in severe MS (
CO)
Precordial bulge
Left parasternal pulsations ( RVH)
Epigastric pulsations ( RVH)
Clinical signs
Palpation
Apex beat classical tapping
Left parasternal heave (RVH)
Palpable P2 ( diastolic shock)
Diastolic thrill at apex
Percussion
Cardiomegaly ( RV type)
PA impaired note/ dullness (PA
dilatation)
Clinical signs
Auscultation
Loud S1 ( M1)
Presystolic accentuation
Louder the S1
Congenital
Left atrial myxoma
Cor triatriatum
Ball valve thrombus
TS
Rheumatic MS
Commonest cause of MS
50% give Rheumatic h/o
Best between 5-15 years
OS is common
Congenital sequelae absent
Juvenile MS
Calcification of LA
Auscultation type in MS
ECG changes in MS
LA enlargement ( P mitrale)
RVH
RV strains pattern
RBBB/ RV dominance pattern
Atrial fibrillation
Investigations
ECHO cardiography
-for definite diagnosis of MS
-to assess the severity of MS
-to assess the transmitral flow &
complications of MS
Cardiac catherisation
-to assess the hemodynamics of the
heart
Complications of MS
Mechanical Rhythm
Treatment of CCF
Treatment of AF
Prophylaxis of RF
Prophylaxis of IE
Surgery indications
Symptomatic MS
Critical MS
Pulmonary oedema
Low output state
Evidence of systemic embolism
Failed medical line of treatment
Option of surgery in MS