Mitral Steonosis Case

7/25/2019 Mitral Steonosis Case

1/16

Mohammed Sanwar

Hussain

2011 AutumBatch,201121009

Taishan Medical University

5thyear sectionA


2/16

!ase1

A "2 year old male #resents with dys#nea

and hemo#tysis$ He is a%e&rile, heart rate

100 &eats #er minute, &lood #ressure

120'(0, and res#irations 22'min$ His cardiac

#hysical e)amination reveals a so%t, **'*+

early diastolic murmur at the cardiac a#e)$ A

&ronchosco#y is neative %or any lesion ormalinancy$-chocardiora#hy will li.ely

reveal


3/16

!ase2

A /5 year old %emale #resents with dys#nea with a

moderate amounto% e)ertion$ She can wal. u# two %lihts

o% stairs or two &loc.s &e%ore havin to rest which is new

%or her ew or. Heart Association %unctional class **3$

She has no lower e)tremity edema, #aro)ysmalnocturnaldys#nea or ortho#nea$ 4hysical e)amination reveals a loud

S1 heart sound and an middiastolic decrescendo murmur

at the cardiac a#e) a%ter an o#enin sna# which has a late

systolic accentuation$


4/16

!ase"

A 65 year old woman with loud %irst heart

sound and middiastolic murmur

7 !hronic dys#nea

!lass 2'/

7 8atiue7 ecent ortho#nea

7 octurnal #al#itation

7 4edal edema7 hoarseness


5/16

econi:in

4al#ation;

7 Small volume #ulse

7 Ta##in a#e)#al#a&le

S17


6/16

>a&oratory Studies

7 4er%orm routine

&aseline tests such as

!B! count,

electrolyte status, andrenal and liver

%unction tests$

Test esultormal


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!hest radiora#hic %indins

7 dou&le shadow in the

cardiac silhouette

7 straihtenin o% le%t

cardiac &order due tothe lare le%t atrial

a##endae

7 u#ward dis#lacement

o% the mainstem

&ronchi


8/16

!ontinuin Medical *m#lementation $$.bridging thecare gap

A 75 year old woman with loud first heart

sound and mid-diastolic murmer


9/16


10/16

!ontinuin Medical*m#lementation


11/16


Mitral Stenosis:Therapy

MedicalDiuretics for L!"#!

Di$italis"%eta &loc'ers": #ate control in A !i&Anticoa$ulation: (n A !i&

%alloon )al)uloplasty*ffecti)e lon$ term impro)ement


12/16


Mitral Stenosis:Therapy

Sur$ical

Mitral commissurotomy

Mitral +al)e #eplacement

Mechanical

%ioprosthetic


13/16

Diet and Activity

7 The #atient should start a

lowsalt diet i% #ulmonary

vascular conestion is

#resent$

7 *n most #atients with

mitral stenosis,

recommendations %or

e)ercise are sym#tom

limited$ 4atients should&e encouraed to #ursue

a lowlevel aero&ic

e)ercise #roram %or

maintenance o%cardiovascular %itness$


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8ollowu#

7 All #atients should &e in%ormed that any chane in

sym#toms warrants reevaluation$

7 *n the asym#tomatic #atient, yearly reevaluation is

recommendedC history, #hysical e)amination, chest

radiora#h, and echocardioram -!D3 should &eo&tained$

7 An echocardioram is not recommended yearly unless

there is a chane in clinical status or the #atient has severe

mitral stenosis$7 Am&ulatory -!D monitorin Holter or event recorder3 to

detect #aro)ysmal atrial %i&rillation is indicated in #atients

with #al#itations$


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Mitral Steonosis Case

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