Dr. Usman's Cardiology Notes

  We're going to talk about mitral stenosis it's like about the features the symptoms the physical diagnosis the diagnosis treatment and when to do surgery on mitral stenosis so almost all mitral stenosis is related to rheumatic heart disease remember what rheumatic heart disease is you have an infection and then you have these antibodies that are floating around that would like to attack bacteria but instead they attack your valves and specifically we're talking about this mitral valve here typically this occurs 20 years after rheumatic heart disease and we usually see romatic heart disease in there we'll countries for some reason in the tropics it tends to occur more quickly it's sped up than it does in the more northern latitudes we're not exactly sure why that might be but think about this in 30 year old patients it may be younger if you're talking about in the more tropical areas of the world you're going to see this in the 30 year old ...

We are moving from coronary to valve here. This is 37 year old lady of Rheumatic mitos stenosis. I can see here she is in atrial fibrillation and left atrial appendage claw type one A as based on our classification, she was anticoagulated for three months. So she's in function class three. Atrial fibrillation and heart rate on the table is about 120. Blood pressure is 100 and 2120 by 80. And we'll show the other pictures. This is next atal fibrillation. This is typical x ray of Rheumatic mitostinosis pulmonary hypertension. And you can see here, the parasternal angaxis shows dooming of the mitral valve and bit of calcium on the posterior mitral leaflet. Then in the left lower panel you can see the short axis of the mitral valve. That Rfize is less than one. And there is tr and there is pulmonary artery potential is around 70 pulmonary arteries pressure is 70. If you look at the short axis of the mitral valve, the antilateral commissioner ...

A 22 years old female presented with dyspnea on exertion and hoarseness of voice for last six months. Examination revealed loud first heart sound with diatolic murmur and tapping apex beat. ECG revealed p mitrale and sinus rhythm. Echocardiogram revealed MV orifice area of 1 cm 2 . Please answer the following: a) What is Ortner’s Syndrome? b) What is new scoring system for deciding surgical vs percutaneous treatment? c) How will you calculate valve area on cardiac catheterization? d) What are the contraindications to percutaneous transmural balloon valvuloplasty? Answers: a.       Hoarseness occurs when dilated left atrium impinges on the recurrent laryngeal nerve b.       Hung Scoring system c.        By Gorlin Equation d.       The following are contraindications for PMBV (ie, class III recommendations):     Percutaneous mitral balloon valvotomy is not indicate...

A 25 years old female presented in cardiology clinic with DOE for last 6 months, now worsened cough to affect her daily activities, she also complained of intermittent palpitations. On examination her BP was 100/60mmHg with regular pulse of 90bpm, pedal edema and giant ‘a’ wave on JVP. Auscultation revealed soft S1 and mid-diastolic rumble at apex and sternal end. Murmur accentuated on expiration as well as on leg raising and squatting. Lungs were clear. ECG showed bi-atrial enlargement a)       What is diagnosis? b)       What is the reason for soft S1 and giant ‘a’ wave in JVP c)       Why diastolic murmur accentuated on leg raising and squatting d)       What are some of the limitations of calculating PH based on TR jet Answers: a. MS and TS b. Soft S1 is due to severely calcified valve and giant ‘a’ wave is due to TS c. Increased venous return and flow through stenotic tricuspid val...