Our patient’s diagnosis is severe rheumatic mitral stenosis with pulmonary hypertension and right heart failure.
When she was seen for this evaluation, she had symptoms of pulmonary congestion and was treated by further restricting her salt intake, increasing her dose of diuretic, and adding a beta blocker for rate control.
Atrial fibrillation is common in mitral stenosis. Patients with mitral stenosis and atrial fibrillation, paroxysmal atrial fibrillation, or prior embolic events should be anticoagulated with warfarin.
She lost several pounds, her symptoms of nocturnal dyspnea improved, and her ankle edema resolved.
However, she was still dyspneic with such routine activities as light housework and carrying only a few items while grocery shopping. She also continued to require two pillows to breathe comfortably at night.