Clinical Features

Even though mitral stenosis is a chronic condition, increased demands on cardiac output may precipitate acute symptoms. Conditions that prompt symptoms in mitral stenosis include exertion, tachycardia, anemia, pregnancy, infection, emotional upset, and atrial fibrillation. As with all valvular diseases, exertional dyspnea is the most common presenting symptom (80 percent of patients with mitral stenosis). Paroxysmal nocturnal dyspnea may occur with more severe disease. Hemoptysis is the second most common presenting symptom and may be massive if a bronchial vein ruptures. Other common symptoms and signs include orthopnea, premature atrial contractions, and atrial fibrillation, which is almost inevitable with the passage of time. Systemic emboli may occur and result in myocardial, kidney, central nervous system, or peripheral infarction. Embolic stroke is more frequent in the presence of atrial fibrillation. As the disease progresses, symptoms of right heart failure may develop.

Signs of mitral stenosis include middiastolic rumbling murmur, with crescendo toward the S2. With the onset of atrial fibrillation the presystolic accentuation of the murmur disappears. Typically the S-i is loud and is followed by a loud opening "snap" that is high-pitched and heard best at the right of the apex. A prominent a wave in the neck may be seen, as may an early systolic parasternal lift, which is due to right heart pressure overload. The apical impulse is small and tapping, representing an underfilled left ventricle. Systemic blood pressure is typically normal or low. Rales may be heard at the lung bases as the disease progresses. If pulmonary hypertension is present, signs may include a thin body habitus, peripheral cyanosis, and cool extremities because of low cardiac output. With pulmonary hypertension the auscultatory findings are less evident.

The electrocardiogram (ECG) may demonstrate notched or diphasic P waves and right axis deviation. On the chest radiograph, straightening of the left heart border, indicating left atrial enlargement, is a typical early radiographic finding. Eventually, findings of pulmonary congestion are noted: redistribution of flow to the upper lung fields, Kerley B lines, and an increase in vascular markings. The chest radiograph is useful in assessing the degree of pulmonary congestion.

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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