The diagnosis of severe rheumatic mitral valvular stenosis is supported by the patient’s history suggesting rheumatic fever during childhood and congestive failure during the third trimester of pregnancy. Progressive fatigue and dyspnea on exertion, with subsequent orthopnea and ankle edema, are evidence that the lesion is severe and is associated with pulmonary hypertension and right heart failure. Her palpitations are consistent with the paroxysmal atrial tachyarrhythmias that typically occur with mitral valve disease.

Her physical examination demonstrated a narrow pulse pressure, an hypokinetic carotid arterial pulse, a pathologic jugular venous “cv” wave, prominent right sided precordial impulses of the pulmonary artery and right ventricle, the classic murmur of severe mitral stenosis and the murmur of severe tricuspid regurgitation due to pulmonary hypertension and right heart failure. In addition, pulmonary auscultation revealed inspiratory crackles and expiratory wheezes, reflecting chronic severe pulmonary congestion and bronchospasm.

Etiology

The etiology of mitral stenosis is nearly always rheumatic. It may rarely be congenital and the disease may be mimicked by left atrial myxoma. In addition, with the aging population, mitral annular calcification is a growing but still infrequent cause of mitral stenosis.