Moffitt Cardiology Report Pearls 10/6: Mitral Stenosis

Take-home pearl: in patients with mitral stenosis and tachycardia, heart rate control with beta-blockade is important to increase the diastolic filling time across the stenotic valve, decrease LA and pulmonary pressures and improve cardiac output

Additional learning:

  • Stroke prevention: in mitral stenosis + Afib, there is a ~10x increased stroke risk in general so need anticoagulation. Can’t use NOAC in valvular Afib. Don’t even need to calculate a CHADS2-Vasc given this increased risk at baseline.
  • Wilkins score helps grade the degree of mitral valve deformity and will guide therapy. Lower scores are more amenable to percutaneous mitral valve balloon valvuloplasty. This is an echocardiographic score looking at leaflet mobility, valve thickness, subvalvular thickening and calcification
    • Patients with a score of 8 or less have better outcomes (total score out of 16)
  • Mitral valve stenosis severity: remember “5 and 10” as a rough guide for the transvalvular gradient
    • <5 = mild
    • 5-10 = moderate
    • >10 = severe
  • Rheumatic heart disease
    • Acute rheumatic fever: causes a pancarditis that affects pericardium, epicardium, myocardium, endocardium. This includes affecting the valves and mitral regurgitation is the most common valve lesions early on
    • Transitions to chronic valvular disease in subsequent years (mitral > aortic)

Evernote link: http://www.evernote.com/l/APibnFZSEW1KeZa5ixORShPWhHFYGDNk-pI/

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