Mitral valve disease is suggested by a likely episode of rheumatic fever during childhood, the long interval that followed before the onset of symptoms, and a likely episode of congestive failure during the third trimester of pregnancy.

Her symptoms over the last year reflect the severity and natural history of the lesion. Her fatigue is consistent with low cardiac output and her progressive dyspnea is consistent with pulmonary venocapillary hypertension and congestion. This, in turn, has resulted in right heart failure, reflected by peripheral edema. Her palpitations suggest paroxysmal atrial arrhythmia, a common complication of mitral valve disease.