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Mitral Stenosis and Mitral Regurgitation: Etiology, Clinical Features, Diagnosis, Treatment, and Complications
Mitral Stenosis
Mitral stenosis is a narrowing of the mitral valve opening, which impedes blood flow from the left atrium to the left ventricle. Etiology is most commonly rheumatic fever, which causes scarring and thickening of the valve leaflets. Other causes include congenital abnormalities, calcification, and infective endocarditis. Clinical features often develop gradually and include exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, palpitations, and hemoptysis. Physical examination may reveal a low-pitched, rumbling diastolic murmur best heard at the apex with the patient in the left lateral decubitus position. Diagnosis involves echocardiography to assess the severity of stenosis, the presence of associated mitral regurgitation, and left atrial enlargement. Electrocardiogram (ECG) may show atrial fibrillation or left atrial enlargement, and chest X-ray can reveal left atrial enlargement and pulmonary congestion. Treatment includes medical management with diuretics, beta-blockers, calcium channel blockers, or digoxin to control symptoms and heart rate. Percutaneous mitral balloon valvotomy and surgical mitral valve replacement are options for severe cases. Complications include atrial fibrillation, thromboembolism, pulmonary hypertension, and right-sided heart failure.
Mitral Regurgitation
Mitral regurgitation (MR) is a condition where the mitral valve fails to close properly, allowing blood to flow backward into the left atrium during systole. Etiology includes mitral valve prolapse, rheumatic heart disease, infective endocarditis, ischemic heart disease, and degenerative changes of the mitral valve apparatus. Clinical features can be acute or chronic. Acute MR presents with severe symptoms of heart failure and pulmonary edema. Chronic MR may be asymptomatic for years and then develop symptoms such as exertional dyspnea, fatigue, palpitations, and orthopnea. Physical examination typically reveals a high-pitched, blowing holosystolic murmur best heard at the apex and radiating to the axilla. Diagnosis involves echocardiography to determine the severity and mechanism of regurgitation, left ventricular function, and left atrial size. ECG and chest X-ray are used to assess atrial enlargement and pulmonary congestion. Treatment for chronic MR includes medical management with vasodilators, diuretics, and rate control for atrial fibrillation. Surgical options, such as mitral valve repair or replacement, are considered in severe cases, especially when symptoms are present or left ventricular function declines. Complications include heart failure, atrial fibrillation, pulmonary hypertension, and left ventricular dysfunction.
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