Mitral stenosis

Mitral stenosis or regurgitation Mitral valve prolapse Chronic obstructive pulmonary disease Pulmonary embolism Idiopathic ("lone" atrial fibrillation) Thoracic surgery ... 

JRA Juvenile rheumatoid arthritis MS Mental status mitral stenosis musculoskeletal mul-... 

AF or atrial flutter may be manifested by the entire range of symptoms associated with other supraventricular tachycardias, but syncope is not a common presenting symptom. An additional complication of AF is arterial embolization resulting from atrial stasis and poorly adherent mural thrombi, which accounts for the most devastating complication embolic stroke. Patients with AF and concurrent mitral stenosis or severe systolic HF are at particularly high risk for cerebral embolism. 

Unlabeled Uses Graft patency (saphenous vein), mitral regurgitation, mitral stenosis, noncardioembolic stroke, percutaneous coronary intervention... 

Clinicians from Hong Kong reported a case of potential danshen-warfarin interaction in a 48-year-old female with a history of rheumatic heart disease, atrial fibrillation, and mitral stenosis (11). The patient underwent successful transvenous mitral valvuloplasty for management of her medical conditions, and was discharged with 1 mg warfarin, as well as... 

Rheumatic mitral valve disease is associated with thromboembolic complications at reported rates of 1.5 to 4.7% per year the incidence in patients with mitral stenosis is approximately 1.5 to 2 times that in patients with mitral regurgitation. The presence of atrial fibrillation is the single most important risk factor for thromboembolism in valvular disease, increasing the incidence of thromboembolism in both mitral stenosis and regurgitation four- to sevenfold. In current practice, patients with nonrheumatic atrial fibrillation at low risk for thromboembolism based on clinical characteristics frequently are treated with aspirin. Warfarin therapy is considered in higher-risk patients, especially those with previous thromboembolism and in whom anticoagulation is not contraindicated due to preexisting conditions. 

Mitral stenosis is seen typically as a consequence of chronic rheumatic fever. Isolated congenital mitral stenosis is very rare and not suitable for balloon valvuloplasty. Clinical symptoms depend on the degree of obstruction. Dyspnea, atrial fibrillation, embolic events, pulmonary edema, and right heart decompensation may occur and are all indications for treatment. Surgery and catheter intervention provide similar results. Balloon valvuloplasty produces best results in patients with little or no calcification of the mitral leaflets (20—23). 

Lock JE, Khalilullah M, Shrivastava S, et al, Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N Engl J Med 1985 3 13(24) 1515-1518. 

Q13 Arterial emboli, which can block blood vessels and cause ischaemia or infarction in the tissues they affect, tend to originate in the left heart and are associated with valvular disease and dysrhythmias. Mitral stenosis is associated with abnormal atrial rhythm, particularly atrial fibrillation. Fibrillation and other rhythm abnormalities in the atria favour blood coagulation, resulting in production of thromboemboli which can move to distant parts of the circulation, such as the cerebral circulation. Thrombi could also form on surfaces of valves distorted by calcification and other abnormalities. In view of the risks of thromboembolism, it is usual to provide anticoagulant therapy to patients with mitral valve problems and atrial fibrillation. 

Thorough cardiac examination should look for possible cardiac source of embolism, including atrial fibrillation, mitral stenosis and prosthetic heart valves. Left ventricular hypertrophy suggests hypertension or aortic stenosis, and a displaced apex from a dilated left ventricle indicates underlying cardiac or valvular pathology. 

Left ventricular thrombus Left ventricular dyskinesis Mitral stenosis Mitral annulus calcification Aortic stenosis... 

In October, 1981, a 39-year-old man with mitral stenosis was hospitalized for mitral valve replacement. 

INR 2.0-3.0 Treatment of deep vein thrombosis pulmonary embolism systemic embolism prevention of venous thromboembolism in myocardial infarction mitral stenosis with embolism transient ischaemic attacks atrial fibrillation. 

Baroreceptors are present in the carotid sinus and aortic arch and stretch receptors are situated in the left atrium (G2, H6). Distension of the left atrium causes a fall in blood ADH levels, and in experimental animals the reduction in atrial stretch which follows the deflation of a distended balloon produces a brisk rise (S3). These experimental results offer an explanation of the dilutional situation with water retention which follows the surgical release of a tight mitral stenosis in man. 

Snashall, P.D. and Chung, K.F. (1991). Airway obstruction and bronchial hyperresponsiveness in left ventricular failure and mitral stenosis. Am. Rev. Respir. Dis. 144, 945-956. 

Cautions Recent major surgery (Coronary artery bypass graft, OB delivery, organ biopsy), cerebrovascular disease, recent GI or GU bleeding, hypertension, mitral stenosis with atrial fibrillation, acute pericarditis, bacterial endocarditis, hepatic/renal impairment, diabetic retinopathy, ophthalmic hemorrhaging, septic thrombophlebitis, occluded AV cannula at an infected site, advanced age, those receiving oral anticoagulants... 

ECHO remains the procedure of choice in the diagnosis and evaluation of a number of conditions such as valvular dysfunction (aortic and mitral stenosis and regurgitation and endocarditis), wall motion abnormalities associated with ischemia, and congenital abnormalities, such as ventricular or atrial septal defects. Images obtained from ECHO are used to estimate chamber wall thickness and left ventricle ejection fraction, assess ventricular function, and detect abnormalities of the pericardium such as effusions or thickening. 

These rhythms are usually not directly life-threatening, nor do they generally cause hemodynamic collapse or syncope, but 1 1 atrial flutter (ventricular response 300 beats per minute) is an exception. Also, patients with underlying forms of heart disease that are heavily reliant on atrial contraction to maintain adequate cardiac output (e.g., mitral stenosis and obstructive cardiomyopathy) will display more severe symptoms of atrial fibrillation/flutter. 

Atrial fibrillation—most important and treatable cardiac cause of stroke Mitral stenosis Mitral annular calcification Left atrial enlargement... 

Moderate-risk conditions Mitral valve prolapse with valvular regurgitation or leaflet thickening, isolated mitral stenosis, tricuspid-valve disease, pulmonary stenosis, and hypertrophic cardiomyopathy... 

Trace elemeuts were measured iu myocardial and muscle-tissue samples from 13 patieuts diaguosed with idiopathic dilated cardioutyopathy (IDCM). The subjects had no history of Hg exposure. Findings were compared with Hg concentrations measured in n ocardi and muscle biopsies from age-matched patients with valvular (12 patients) or ischemic heart disease (13 patients), papillary and skeletal-muscle biopsies from 10 patients with mitral stenosis, and left-ventricle endomyocardial biopsies from 4 normal subjects. Hg concentrations in myocardial samples collected from patients with IDCM were... 

Population-based echocardiographic studies in the United States estimate that about 2.5% of the population have moderate to severe valvular dysfunction (1). Of the cardiac valvular disease categories reported, mitral regurgitation was found to be the most prevalent (1.7%), followed by aortic regurgitation and stenosis (0.5% and 0.4% respectively), while mitral stenosis was the least common (0.1%). The incidence of heart disease increased with age (0.7% between age 18 and 44 and 13.3% in subjects 75 years or older). There was a 1.36-fold increase in overall adjusted mortality in patients with valvular dysfunction compared to those without (1). 

Against this backdrop, research into less invasive approaches to treat valvular disease has been intensified. In the surgical realm, minimally invasive techniques, with its attendant patient and procedural related limitations, have been tried with some success but traditional valvular operations still remain the norm. At the same time, great strides have been made in percutaneous approaches to treatment of valvular disease. Two valvular disease states in which percutaneous balloon valvuloplasty have had great success are in the treatment of pulmonic stenosis and mitral stenosis. 

Since the publication of the initial findings of EVEREST in 2005, additional follow-up analyses of the MitraClip have been either published or reported at national conferences. Serial echocardiographic monitoring of study participants in whom MitraClip devices were successfully deployed demonstrated no significant mitral stenosis after one year of follow-up (22). 

Reyes VP, Raju BS, Wynne J, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. NEJM 1994 331 961-7. 

Adult respiratory distress syndrome Pulmonary hypertension-associated edema (cardiogenic) Congestive heart failure Mitral stenosis Hypoalbuminemia Veno-occlusive disease Lymphatic dysfunction Unknown mechanisms High-altitude pulmonary edema Neurogenic pulmonary edema Narcotic-induced pulmonary edema... 

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