Mitral stenosis

Background

• Most likely cause is rheumatic fever

Clinical Features

• Mid-diastolic murmur
• Symptoms
  • Exertional dyspnea
  • PND
  • Acute pulmonary edema
  • R-sided HF symptoms
  • Hemoptysis (pulmonary htn > ruptured bronchial vein)
  • Precipitants:
    • Anemia
    • Pregnancy
    • Infection
    • A-fib

Evaluation

• ECG
  • RAD
  • Biphasic P waves
  • Most common arrhythmia is AF
• CXR
  • Straightening of right heart border

Differential Diagnosis

Valvular Emergencies

• Mitral stenosis
• Mitral regurgitation
  • Mitral valve prolapse
• Aortic stenosis
• Aortic regurgitation

Management

• Diuretics
  • Alleviates pulmonary congestion
• A-fib treatment
• Hemoptysis
  • Consider transfusion / surgery consult
• Endocarditis prophylaxis after replacement

Complications

• Systemic emboli
• CHF
• Atrial fibrillation
• Endocarditis

See Also

• Valvular Emergencies
• Heart Murmurs