MITRAL STENOSIS AND ANESTHETIC MANAGEMENT


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1 : ANESTHESIA FOR A PATIENT OF MITRAL STENOSIS DR.SANDEEP SAINI LLRM COLLEGE MEERUT U.P. INDIA
2 : INDEX INTRODUCTION ETIOLOGY & PATHOLOGY PATHOPHYSIOLOGY SYMPTOMS AND SIGNS DIAGNOSIS ANESTHETIC MANAGEMENT
3 : INTRODUCTION- Mitral stenosis is the narrowing of mitral orifice as a result of diffuse thickening of valve leaflets by fibrous tissue and calcific deposits. ETIOLOGY AND PATHOLOGY-Most common cause of mitral stenosis is rheumatic heart disease. Females are affected more than males. Less common – carcinoid syndrome, left atrial myxoma, cor triatriatum, rheumatoid arthritis, systemic lupus erythematosus congenital. Thickening of valve leaflets and cusps become rigid. Fusion of mitral commissures. Shortening and fusion of chordae tendinae. All the changes leads to funnel shaped (fish mouth) valve. Calcification immobilize the leaflets and narrows the orifice further.
4 : PATHOPHYSIOLOGY Cardiac changes- Normal valve area: 4-6 cm2 Mild mitral stenosis: MVA 1.5-2.5 cm2 Minimal symptoms Mod mitral stenosis MVA 1.0-1.5 cm2 usually does not produce symptoms at rest Severe mitral stenosis MVA < 1.0 cm2 Symptoms at rest Mean gradient: >10 mmHg ? Severe 5-10 mmHg ? Moderate <5 mmHg ? Mild
5 : Pathophysiology
6 : Pulmonary changes Pulmonary arterial hypertension results as- 1)Increased left atrial pressure. 2)Pulmonary arterial constriction. 3)Interstitial edema in the wall of the small pulmonary vessels. 4)Organic obliterative changes in the pulmonary vascular bed. At last if there is severe pulmonary arterial hypertension?Tricuspid regurgitation Pulmonary in competence Rt sided heart failure
7 : HEMODYNAMIC CHANGES THAT OCCURS AT VARIOUS STAGES OF SEVERITY OF MITRAL STENOSIS
8 : Symptoms Breathlessness Fatigue Oedema, ascites Palpitation Haemoptysis Cough Chest pain Hoarseness Mitral facies or malar flush Symptoms of thromboembolic complications (e.g. stroke, ischaemic limb) Are worsened by conditions that demand increase in cardiac output. Exertion,fever, anemia, pregnancy, thyrotoxicosis
9 : NYHA FUNCTIONAL CLASSIFICATION OF PATIENT WITH HEART DISEASE CLASS ? -Asymptomatic CLASS ?? –Symptoms with ordinary activity but comfortable at rest. CLASS ??? –Symptoms with minimal activity but comfortable at rest. CLASS ?V – Symptoms at rest
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