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Mohammed Sanwar

Hussain
2011 Autum
Batch,201121009
Taishan Medical University
5th year section-A

Case-1
A 32 year old male presents with dyspnea
and hemoptysis. He is afebrile, heart rate
100 beats per minute, blood pressure
120/80, and respirations 22/min. His cardiac
physical examination reveals a soft, II/IV
early diastolic murmur at the cardiac apex. A
bronchoscopy is negative for any lesion or
malignancy.Echocardiography will likely
reveal

Case-2
A 45 year old female presents with dyspnea with a
moderate amount of exertion. She can walk up two flights
of stairs or two blocks before having to rest which is new
for her (New York Heart Association functional class II).
She has no lower extremity edema, paroxysmal nocturnal
dyspnea or orthopnea. Physical examination reveals a loud
S1 heart sound and an mid-diastolic decrescendo murmur
at the cardiac apex after an opening snap which has a latesystolic accentuation.?

Case-3
A 75 year old woman with loud first heart
sound and mid-diastolic murmur
Chronic dyspnea
Class 2/4
Fatigue
Recent orthopnea
Nocturnal palpitation
Pedal edema
hoarseness

Recognizing
Palpation:
Small volume pulse
Tapping apex-palpable
S1
+/- palpable opening snap
(OS)
Palpable S2

Auscultation:
Loud S1- as loud as S2 in
aortic area
Diastolic rumble: length
proportional to severity
In severe MS with low flowS1, OS & rumble may be
inaudible

Laboratory Studies
Perform routine
Test Result-Normal
baseline tests such as
CBC count,
electrolyte status, and
renal and liver
function tests.

Chest radiographic findings


double shadow in the
cardiac silhouette
straightening of left
cardiac border due to
the large left atrial
appendage

upward displacement
of the mainstem
bronchi

A 75 year old woman with loud first heart


sound and mid-diastolic murmer

Continuing Medical Implementation


care gap

...bridging the

Continuing Medical
Implementation

Mitral Stenosis:Therapy
Medical
Diuretics for LHF/RHF
Digitalis/Beta blockers/: Rate control in A Fib
Anticoagulation: In A Fib

Balloon valvuloplasty
Effective long term improvement
Continuing Medical Implementation
care gap

...bridging the

Mitral Stenosis:Therapy
Surgical
Mitral commissurotomy
Mitral Valve Replacement
Mechanical
Bioprosthetic

Continuing Medical Implementation


care gap

...bridging the

Diet and Activity


The patient should start a
low-salt diet if pulmonary
vascular congestion is
present.

In most patients with


mitral stenosis,
recommendations for
exercise are symptom
limited. Patients should
be encouraged to pursue
a low-level aerobic
exercise program for
maintenance of
cardiovascular fitness.

Follow-up
All patients should be informed that any change in
symptoms warrants re-evaluation.
In the asymptomatic patient, yearly re-evaluation is
recommended; history, physical examination, chest
radiograph, and echocardiogram (ECG) should be
obtained.
An echocardiogram is not recommended yearly unless
there is a change in clinical status or the patient has severe
mitral stenosis.
Ambulatory ECG monitoring (Holter or event recorder) to
detect paroxysmal atrial fibrillation is indicated in patients
with palpitations.