Mitral Stenosis
Etiology
Congenital
Epidemiology
Autoimmunity
-Less common and includes a wide range of anatomic variants
-In response to group A beta-hemolytic streptococcal M protein antigens
-Leads to inflammation and scarring of valvular leaflets
-Scarring causes leaflets to become fibrous and fused
-Chordae tendineae cordis becomes shortened
-Prevalence ~0.1% in the United States
-Rheumatic heart disease incidence in US has steeply declined over the past 4 decades (multifactorial reasons)
-Still major cause of cardiovascular disease in developing nations
-15.6 million people suffer from rheumatic heart disease world wide
-Approximately 282,000 new cases and 233,000 related deaths each year
Other Causes
-Infective endocarditis
-Systemic Lupus Erythematosus
-Rheumatoid arthritis
-Carcinoid heart disease
-Severe calcification of the mitral annulus
Mortality/Morbidity
-10 year survival rate in untreated patients ~ 50-60%
-Cause of death usually due to: cadiopulmonary failure (60-70%), systemic embolism (20-30%), pulmonary embolism (10%), & infection (1-5%)
Diagnosis
Physician assessment
-History
-Auscultation of murmur
Diagnostics
-Transthoracic echocardiogram
-12-lead electrocardiogram
-Chest Xray
-Tansesophageal echocardiogram
Treatment and Management
Diuretics
-Decrease preload
-Decrease pulmonary congestion
Anticoagulants
-Prevent blood clots in the presence of atrial arrhythmia
Beta blocker/Calcium channel blocker
-Slow heart rate
-Allow left ventricle fill more effectively
Antiarrhythmic
-Treat Atrial arrhythmia
-Increase cardiac output (when regular rhythm achieved)
Antibiotics
-To prevent reoccurence of rheumatic heart disease
Mitral valve repair
Surgical
-Open heart commissurotomy
-Tissue or mechanical valve
Non-surgical
-Balloon Valvuloplasty
Clinical Manifestations
Decreased Preload (decreased ventricular filling)
-Decreased cardiac output
-Fatigue (pronounced on exertion)
-Dizziness or fainting
-Headache
Left atrial hypertrophy
-Atrial enlargement
-Heart palpitations
-Atrial arrhythmia
-Chest discomfort or chestpain
Increased pulmonary vascular pressures
-Pulmonary congestion
-Pulmonary edema
-Coughing &Hemoptysis
-Dyspnea on exertion
-Orthopnea
Right sided heart failure
-Right Jugular venous distention
-Lower extremity edema
-Hepatic dysfunction
-Excessive fatigue
-Decreased appetite