Rheumatic mitral valve disease

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. 

Atrial fibrillation with mitral valve disease has long been considered a stroke risk factor. Recurrent embolism occurs in 30-65% of patients with rheumatic mitral valve disease who have a history of a previous embolic event. Most of these recurrences (around 60%) develop within the first year. Mechanical prosthetic valves are a prime site for thrombus formation and patients with these valves require anticoagulation [7, 38]. Bacterial endocarditis can cause stroke as well as intracerebral mycotic aneurysms. Because mycotic aneurysms are inflammatory defects in the vessel wall, treatment with systemic thrombolysis or anticoagulation can lead to rupture with subsequent lobar hemorrhage. Nonbacterial, or marantic, endocarditis is also associated with multiple embolic strokes. This condition is most common in patients with mucinous carcinoma and may be associated with a low-grade disseminated intravascular coagulation. A nonbacterial endocarditis, called Libman-Sacks endocarditis, occurs in patients with systemic lupus erythematosus (SLE) [42],... 

Rheumatic fever is now less common in developed countries, but in Hannah s youth it was an important cause of heart disease. The illness is due to infection with beta-haemolytic ( -haemolytic) streptococci, which cause a sore throat. In some young people, the bacterium induces antibody-mediated autoimmune responses, which initiate inflammatory changes in joints and heart valves, particularly in the mitral valve. Inflammation thickens and may partly fuse the cusps ofthe mitral valve, making it narrow and unable to close properly in ventricular systole. Eventually, cardiac output decreases and the ventricle begins to fail from overwork. Since blood is not pumped effectively from the left ventricle, pulmonary congestion develops. 

Surgically constructed systemic pulmonary shunts or conduits Acquired valvular dysfunction (e.g., rheumatic heart disease) Hypertrophic cardiomyopathy Mitral valve prolapse with regurgitation Intravenous drug abuse... 

In the past, rheumatic heart disease was a prevalent risk factor for IE, but the incidence of this disease continues to decline. The risk of IE in persons with mitral valve prolapse and regurgitation is small however, because the condition is prevalent, it is an important contributor to the overall number of IE cases. Prosthetic valve endocarditis occurs in 1 % to 4% of patients undergoing valve replacement surgery. ... 

Previous coronary artery bypass graft surgery Mitral valve prolapse without valvar regurgitation Physiologic, functional, or innocent heart murmurs Previous Kawasaki disease without valvar dysfunction Previous rheumatic fever without valvar dysfunction Cardiac pacemakers (intravascular and epicardial) and implanted defibrillators... 

Possible severe heart failure if patient has cardiac disease, such as hypertrophic cardiomyopathy, mitral stenosis, rheumatic heart disease, or prosthetic mitral valve. 

Myocardial ischemia. Ml, or aneurysm coronary artery disease rheumatic heart disease mitral valve prolapse heart failure cardiomyopathy ventricular catheters hypokalemia hypercalcemia hypomagnesemia and pulmonary embolism. 

Heart failure, chronic obstructive pulmonary disease, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, or complication of coronary bypass or valve replacement surgery. 

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