Aortic regurgitation, 424.1
Aortic stenosis, 424.1
Mitral regurgitation, 424.0
Mitral stenosis, 394.0
Mitral valve prolapse, 424.0
Valvular disease, 459.9
II. Mitral stenosis.
A. Definition: narrowing of the mitral valve that results in obstructed forward blood flow.
B. Etiology/Incidence.
1. Rheumatic endocarditis from rheumatic fever is most common.
2. Calcification of the valve with scarring
3. Approximately two thirds of patients are female.
C. Subjective and physical examination findings.
1. Fatigue
2. Dyspnea
3. Orthopnea
4. Other findings consistent with left-sided heart failure
5. Palpitations—associated with atrial fibrillation
6. Loud S1 heart sound with low-pitched, mid-diastolic murmur; does not radiate
7. Apical crescendo rumble
E. Management.
1. Digoxin for atrial fibrillation; diltiazem or esmolol may be considered for acute heart rate reduction
2. Diuretics for fluid mobilization
3. Anticoagulants for patients with continued atrial fibrillation
4. Percutaneous transvenous mitral valvotomy (PTMV)—balloon approach for mechanical relief of less calcified valves
5. Surgical valve repair or replacement for patients unresponsive to other therapy
6. Antibiotic prophylaxis for surgical or dental procedures
III. Mitral regurgitation.
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A. Definition: backflow of blood into the left atrium as a result of deficient mitral valve closure.
B. Etiology.
1. Rheumatic disease
2. “Floppy” mitral valve
3. Papillary muscle dysfunction related to ischemic heart disease
4. Infective endocarditis
5. Ruptured chordae tendineae
6. Hypertrophic cardiomyopathy
7. Systemic lupus erythematosus
C. Subjective and physical examination findings.
1. Fatigue
2. Weakness
3. Dyspnea
4. Palpitations—associated with atrial fibrillation
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