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Mitral valve disease

Introduction
  • The mitral valve controls blood flow between the left atrium and left ventricle of the heart.
  • Common mitral valve pathologies include mitral stenosis and mitral regurgitation.
Mitral Stenosis
  • Definition: Narrowing of the mitral valve orifice.
  • Common causes: Rheumatic heart disease, congenital malformations, calcification with ageing.
  • Symptoms: Breathlessness, fatigue, palpitations, and cough. Can lead to atrial fibrillation or heart failure.
  • Physical examination: Opening snap, mid-diastolic murmur.
  • Management: Valve repair or replacement, balloon valvuloplasty.
Mitral Regurgitation
  • Definition: Backflow of blood from the left ventricle to the left atrium.
  • Common causes: Mitral valve prolapse, rheumatic heart disease, endocarditis, cardiomyopathy, and myocardial infarction.
  • Symptoms: Dyspnoea, fatigue, palpitations, and orthopnoea.
  • Physical examination: Pansystolic murmur radiating to axilla.
  • Management: Valve repair or replacement, medications for heart failure (if present).
Investigations
  • Electrocardiogram (ECG): May show atrial fibrillation, left atrial enlargement.
  • Echocardiogram: Gold standard for assessing valve structure and function.
  • Chest X-ray: Might show enlarged heart, signs of pulmonary congestion.
  • Cardiac catheterisation: Detailed assessment of valve and coronary arteries.
Complications
  • Heart failure, atrial fibrillation, pulmonary hypertension, thromboembolism, endocarditis.
Prevention
  • Antibiotic prophylaxis for patients with mitral valve disease undergoing certain procedures to prevent endocarditis.

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