The first time you present a case of mitral stenosis-MS, see that you co relate these points.
The stenosis of mitral valve can present with following findings during clinical examination.
1.pulse may be normal or is decreased in volume
2.tapping apex beat
3.mid diastolic murmur
4.apex beat shifted horizontally and outwards.
and other features like:
5. mitral facies
6.increased JVP if right ventricular failure is present.
. The essence of learning is to know whatever minimum but with understanding.
As far as MS is concerned, the pathology is partial obstruction of blood flow from left atrium to left ventricle.so there is a congestion proximal to mitral valve just like traffic jam when there is a red signal on the road.So all the blood that is pumped from right ventricle gets "jammed" in between pulmonary valve and mitral valve.Since there is a volume overload in this segment of circulatory system from pulmonary valve to mitral valve,pulmonary venous congestion with pulmonary arterial hypertension results.This results in following clinical presentations.
A.progressive exertional dyspnoea.
B.paroxysmal nocturnal dyspnoea.
C.hemoptysis.
D.orthopnoea or acute dypnoea.
EXPLANATION FOR LOW VOLUME PULSE:
mitral stenosis results in decreased left ventricular filling.hence low output state.and low volume pulse
EXPLANATION FOR TAPPING APEX BEAT:
A tapping apex beat means the apex beat or the impulse just hits the palpating finger without the finger being lifted.This is so due to decreased force of left ventricular contraction owing to low end diastolic volume.Low end diastolic volume resulting from decreased left ventricular filling.
EXPLANATION FOR MID DIASTOLIC MURMUR:
The diastole of the cardiac cycle corresponds to atrial contraction.So the turbulence of blood produced by mitral stenosis during left atrial contraction is heard as a murmur during diastole that is between S2 and S1
EXPLANATION FOR APEX BEAT SHIFT:
As mentioned earlier, MS produces pulmonary hypertension. This causes a back pressure in the right ventricle,which has to pump blood against increased resistance.So as to achieve the same, right ventricular hypertrophy takes place.The increased load brings about right ventricular enlargement,which displaces the apex horizontally and outwards.So the apex beat is shifted to left but lies in the 5th intercostal space itself. Where as left ventricular enlargement as in aortic regurgitation shifts the apex downward and outward.So we expect the apex beat in the 6th inter costal space. So if it is a case of MS, see that u find the apex beat in 5th intercostal space itself.
MITRAL FACIES is due to dilated veins of cheek.
The stenosis of mitral valve can present with following findings during clinical examination.
1.pulse may be normal or is decreased in volume
2.tapping apex beat
3.mid diastolic murmur
4.apex beat shifted horizontally and outwards.
and other features like:
5. mitral facies
6.increased JVP if right ventricular failure is present.
. The essence of learning is to know whatever minimum but with understanding.
As far as MS is concerned, the pathology is partial obstruction of blood flow from left atrium to left ventricle.so there is a congestion proximal to mitral valve just like traffic jam when there is a red signal on the road.So all the blood that is pumped from right ventricle gets "jammed" in between pulmonary valve and mitral valve.Since there is a volume overload in this segment of circulatory system from pulmonary valve to mitral valve,pulmonary venous congestion with pulmonary arterial hypertension results.This results in following clinical presentations.
A.progressive exertional dyspnoea.
B.paroxysmal nocturnal dyspnoea.
C.hemoptysis.
D.orthopnoea or acute dypnoea.
EXPLANATION FOR LOW VOLUME PULSE:
mitral stenosis results in decreased left ventricular filling.hence low output state.and low volume pulse
EXPLANATION FOR TAPPING APEX BEAT:
A tapping apex beat means the apex beat or the impulse just hits the palpating finger without the finger being lifted.This is so due to decreased force of left ventricular contraction owing to low end diastolic volume.Low end diastolic volume resulting from decreased left ventricular filling.
EXPLANATION FOR MID DIASTOLIC MURMUR:
The diastole of the cardiac cycle corresponds to atrial contraction.So the turbulence of blood produced by mitral stenosis during left atrial contraction is heard as a murmur during diastole that is between S2 and S1
EXPLANATION FOR APEX BEAT SHIFT:
As mentioned earlier, MS produces pulmonary hypertension. This causes a back pressure in the right ventricle,which has to pump blood against increased resistance.So as to achieve the same, right ventricular hypertrophy takes place.The increased load brings about right ventricular enlargement,which displaces the apex horizontally and outwards.So the apex beat is shifted to left but lies in the 5th intercostal space itself. Where as left ventricular enlargement as in aortic regurgitation shifts the apex downward and outward.So we expect the apex beat in the 6th inter costal space. So if it is a case of MS, see that u find the apex beat in 5th intercostal space itself.
MITRAL FACIES is due to dilated veins of cheek.
Before people said there is no cure for herpes virus but today many people have now believe that there is a cure, herpes virus can be cured through Africans roots and herbs, Dr Itua Herbal Center he is the one of the great herbal doctor in Africa and he has the cure on this virus last month he share his herbal medicine in some medical hospital and now he is well recognize as one of the best in Africa, you don’t have to be sad any more or share your tears any more on this virus or other diseases when the cure have already be find by Dr Itua email him on drituaherbalcenter@gmail.com or https://www.drituaherbalcenter.com
ReplyDelete