THE CONTEXT
Investigations assess mitral valve narrowing, atrial enlargement and pulmonary pressure, while examination may identify accompanying mitral or tricuspid regurgitation.
Murmurs and right heart complications
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In symptomatic mitral stenosis, the murmur extends from the opening snap to the first heart sound.
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Coexisting mitral regurgitation produces a pansystolic murmur radiating towards the axilla.
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Pulmonary hypertension may lead to right ventricular hypertrophy and dilatation with secondary tricuspid regurgitation. Associated findings include a parasternal lift, a systolic murmur and giant v waves in the venous pulse.
Electrocardiography and chest radiography
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The electrocardiogram may show right ventricular hypertrophy with tall R waves in V1–V3, P mitrale or atrial fibrillation.
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Chest radiography may show enlargement of the left atrium and its appendage, together with pulmonary venous congestion.
Echocardiography, Doppler and catheterisation
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Echocardiographic findings include thickened immobile cusps, reduced valve area, an enlarged left atrium and a reduced rate of left ventricular diastolic filling.
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Doppler assessment includes the pressure gradient across the mitral valve, pulmonary artery pressure and left ventricular function.
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Cardiac catheterisation assesses coronary artery disease, pulmonary artery pressure, and mitral stenosis and regurgitation.