Mitral Valve Stenosis: Causes, Symptoms, Diagnosis, and Treatment Explained

Mitral Valve Stenosis: Causes, Symptoms, Diagnosis, and Treatment Explained

Question. Describe clinical features, diagnosis, investigations, and management of rheumatic mitral stenosis.

Answer.

Mitral stenosis is a valvular heart disease. Rheumatic mitral stenosis occurs in elderly people and is most common in females.

Clinical Manifestations of Rheumatic Mitral Stenosis.

Symptoms of Rheumatic Mitral Stenosis.

1. The patient complains of breathlessness and fatigue on exertion.
2. Progression of stenosis leads to dyspnea on rest and even has orthopnea and paroxysmal nocturnal dyspneal.
3. Acute pulmonary edema can also occur.
4. Hemoptysis can be present due to rupture of pulmonary congestion and pulmonary embolism and cough due to pulmonary congestion.
5. Chest pain is present due to pulmonary venous hypertension.

Signs of Rheumatic Mitral Stenosis.

1. Atrial firillation is present.
2. Auscultation: Presence of loud first heart sound, opening snap, and mid-diastolic low-pitched rumbling murmur best heard at the apex.
3. Signs of raised pulmonary capillary pressure: Pleural effusion, crepitation, pulmonary edema.
4. Signs of pulmonary hypertension: RV heave, loud P2
5. Others: Basal crackers, ascites, and pleural effusion

Investigations of Rheumatic Mitral Stenosis.

1. ECG:

1. Right ventricular hypertrophy
2. Left atrial hypertrophy

2. X-ray chest:

1. A prominent left atrial appendage may be seen in the left border of the heart between the pulmonary artery and left ventricle. It indicates left atrial enlargement.
2. Double shadow of enlarged left atrium on the right side of the spine.
3. Signs of pulmonary venous congestion

Mitral Valve Stenosis Causes, Symptoms, Diagnosis, and Treatment

3. Echocardiogram:

1. Show thick immobile mitral cusp
2. Decreased diastolic filling of the left ventricle
3. Decreased valve orifice area
4. Left atrial thrombus, if it is present.

4. Cardiac catheterization is used to assess valvular lesions
and to detect coronary artery disease.

5. Doppler:

1. Pressure gradient across the mitral valve
2. Pulmonary artery pressure
3. Left ventricular function

Diagnosis: Rheumatic Mitral Stenosis.
It is based on physical signs and investigations.

Management of Rheumatic Mitral Stenosis.

Medicinal: Rheumatic Mitral Stenosis.

1. Salt restriction should be done in the diet, or a very low salt diet should be given.
2. Digitalis therapy is given. In the patient with congestive heart failure, Tab. Digoxin 0.25 mg BD is given.
3. Diuretics can be given to control heart failure
4. Anticoagulants such as heparin can be given to prevent embolism
5. Prophylactic oral penicillin V 250 mg BD is given to prevent rheumatic fever. If the patient is allergic of penicillin, erythromycin 250 mg daily orally is given.

Surgical: Rheumatic Mitral Stenosis.
When the patient remains symptomatic despite medical treatment or when mitral stenosis is severe, surgical intervention is needed:

1. Mitral valvotomy:

1. Percutaneous balloon valvotomy is indicated when the mitral valve is noncalcified and without regurgitation.
   The procedure involves the passing of a catheter across the valve and inflation of the balloon to dilate the orifice.
2. Open valvotomy is carried out in patients where balloon valvotomy is not possible or in cases with rest enosis.
   In this procedure, the fusion of the valve is loosened,d and calcium deposits and thrombi are removed.

Causes of Mitral Valve Stenosis

2. Mitral valve replacement: The mitral valve is replaced when there is critical mitral stenosis and/or there is associated mitral regurgitation. Replacement is also done when the mitral valve is severely distorted and calcified.