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Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
There are other causes of mitral stenosis (Table 3.7), but these are rare. In most elderly patients, annular calcification and degenerative changes seldom lead to significant MS as the calcified nodules are usually located at the base of the leaflets, without causing significant restriction of leaflet movement and obstruction to flow. But in the older population with more calcific changes, MS is becoming more frequent (Figs. 3.56a,b). Other causes are extremely rare and may include systemic inflammatory disease (i.e., SLE), infiltrative diseases, and drug-induced valve disease.
Paper 2
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Mitral stenosis is usually caused by rheumatic heart disease. Symptoms include dyspnoea, palpitations, haemoptysis and right heart failure. Signs include: a malar flush which may be a sign of peripheral cyanosis; a left parasternal heave, and an undisplaced tapping apex beat. The pulse is of normal character. After an opening snap there is a loud S1 heart sound. A mid-diastolic murmur best heard at the apex is classical. Chest x-ray and echocardiogram are essential investigations. Diuretics and digoxin may be useful treatment options but mitral valve replacement may be necessary. Endocarditis prophylactic antibiotics are required.
Mitral Stenosis
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Mitral stenosis is characterized by the obstruction of the flow of blood from the left atrium into the left ventricle. A positive history of rheumatic fever may be available in only 30-50% of patients; however, in greater than 90% of cases it is caused by it. Other causes include left atrial myxoma and calcification of the mitral valve annulus. Exertional dyspnoea is the most common presenting symptom; others may include palpitation, chest pain, haemoptysis and thrombo-embolic sequelae. Rarely, a patient may develop hoarseness due to compression of the left recurrent laryngeal nerve by the dilated left atrium.
Focus on valvular heart disease
Published in Acta Cardiologica, 2022
Patrizio Lancellotti, Hélène Petitjean, Adriana Postolache, Bernard Cosyns
While rheumatic mitral stenosis is frequently encountered in young individuals in developing countries, degenerative mitral stenosis is seen in the elderly in developed countries and its prevalence is increasing. Degenerative mitral stenosis is usually a late presentation of mitral annular calcification (MAC). Treatment for mitral stenosis involves medical therapy, percutaneous mitral valvuloplasty, and surgical therapy. Percutaneous mitral balloon valvotomy, has become the procedure of choice for patients with symptomatic severe mitral stenosis who have suitable mitral valve morphology on echocardiography [7]. In this issue, Liu et al. reported the results of the systematic review of the existing literature on the effects of percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis and atrial fibrillation (AF) versus sinus rhythm (SR). Fifteen studies were included involving 6351 patients. Current data seem to suggest that PBMV may be less effective in patients with AF than in those with SR. However, early treatment and appropriate management of AF patients undergoing PBMV can benefit both immediate and long-term outcomes [8].
Factors affecting the outcome of pregnancy with rheumatic heart disease: an experience from low-middle income country
Published in Journal of Obstetrics and Gynaecology, 2019
Vanita Suri, Pooja Sikka, Rimpi Singla, Neelam Aggarwal, Seema Chopra, Rajesh Vijayvergiya
Diagnosis of RHD during pregnancy in 35% of the subjects highlights the importance of cardiovascular examination of all pregnant women. Mitral stenosis is the predominant lesion. Maternal complications including mortality are significantly higher in women with severe MS and severe symptoms (NYHA class III–IV). Gestational age at delivery and birth weight are also significantly lesser in these women. Late access to antenatal care, especially after occurrence of complications, is associated with poor outcome. Optimisation of cardiac status before pregnancy or in early pregnancy is the key to optimal pregnancy outcome for women with RHD. Hence, early registration during pregnancy and early diagnosis are important. BMV can be safely performed during pregnancy when indicated to relieve the stenosis. Among the patients who had severe MS or NYHA III–IV status, the outcome was better in those who had BMV as compared to those who did not. Patients with RHD can safely undergo labour and vaginal delivery under vigilant monitoring by a dedicated multidisciplinary team.
Chronic kidney disease predicts atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention
Published in Acta Cardiologica, 2019
Răzvan Constantin Șerban, Ioana Șuș, Eva Katalin Lakatos, Zoltan Demjen, Alexandru Ceamburu, Paul Ciprian Fișcă, Cristina Somkereki, Laszlo Hadadi, Alina Scridon
A number of classic (age, gender, history of hypertension and heart failure, mitral valve disease, previous myocardial infarction, left atrial antero-posterior diameter) and more novel (body mass index [BMI], diabetes mellitus, CKD, COPD) factors predictive of AF in the general population were evaluated. Mitral valve disease was defined as any degree of mitral stenosis or more than minor mitral regurgitation, as evidenced by echocardiography. As in the vast majority of previous studies [13,14] and clinical trials [15] on STEMI patients, CKD was defined as a calculated creatinine clearance at admission <60 mL/min according to the Cockroft–Gault equation. Similarly to previous studies [16–18], patients were considered to have COPD if this diagnosis was reported in their medical records or if they received COPD-specific pharmacologic therapies (e.g. inhaled steroids, beta-agonists, anticholinergics). The severity of coronary artery disease was assessed using the SYNergy between PCI with TAXUS™ and Cardiac Surgery (SYNTAX I) score. The CHA2DS2-VASc score was recorded as a measure of global cardiovascular morbidity.