Medicine

In MR, the diastolic murmur starts slightly later than in MS, and there is often clear evidence of left ventricular enlargement, while an opening snap (OS) and increased P2 are absent.

Rheumatic fever.

Kerley B lines are fine, dense, opaque, horizontal lines that appear when the resting mean left atrial pressure exceeds ~20 mmHg, resulting from distention of interlobular septae and lymphatics with edema.

Beta blockers, nondihydropyridine calcium channel blockers (e.g., verapamil or diltiazem), and digitalis glycosides.

It has declined considerably due to reductions in acute rheumatic fever.

Pulmonary infections, recurrent pulmonary emboli, and hemoptysis.

4.5%

Symptomatic patients with isolated severe mitral stenosis and an effective orifice area <1 cm²/m² body surface area.

Penicillin prophylaxis is used for secondary prevention of rheumatic fever in patients with rheumatic mitral stenosis.

Dyspnea, cough, orthopnea, paroxysmal nocturnal dyspnea, and limitations in daily activities.

To prevent complications from infection in high-risk patients, including those with a history of endocarditis.

An abnormally elevated left atrioventricular pressure gradient.

It is reduced due to elevated pulmonary venous and arterial wedge pressures.

It is associated with mitral stenosis and follows the sound of aortic valve closure.

Restriction of sodium intake.

Cardiac catheterization can help resolve discrepancies between clinical and noninvasive findings and assess associated lesions.

Commissurotomy should be carried out if pulmonary congestion occurs despite intensive medical treatment.

1. Passive backward transmission of elevated left atrial (LA) pressure, 2) pulmonary arteriolar constriction, 3) interstitial edema in small pulmonary vessels, 4) organic obliterative changes in the pulmonary vascular bed.

Its duration correlates with the severity of the stenosis.

Reversion to sinus rhythm pharmacologically or by electrical countershock.

PMBC has less morbidity and a lower periprocedural mortality rate.

Approximately 70%.

Approximately 2%.

The Austin Flint murmur, associated with severe aortic regurgitation (AR), may be mistaken for MS but can be differentiated as it is not intensified in pre-systole and becomes softer with vasodilators.

It indicates subnormal cardiac output (CO) at rest and potential decline during activity.

An apical pansystolic murmur of at least grade III/VI intensity and an S3 suggest significant MR.

May be twice as high compared to younger patients.

MVR is indicated if the mitral valve area is ≤1.5 cm² and the patient is symptomatic.

4–6 cm².

Tall and peaked P waves suggestive of left atrial enlargement.

Approximately 40%.

Diffuse thickening of valve leaflets, fusion of mitral commissures, and calcification.

Infective endocarditis, papillary muscle rupture post-myocardial infarction, chordal rupture, and blunt trauma.

It provides critical information on mitral inflow velocity, transvalvular gradients, and the presence of associated valvular lesions.

2–3.

Primary (degenerative) MR and secondary (functional) MR.

Approximately 25 mmHg.

It augments the transvalvular pressure gradient and elevates left atrial pressure.

Both conditions may show RV enlargement and accentuated pulmonary vascularity, but ASD lacks LA enlargement and Kerley B lines.

Treatment options include percutaneous mitral balloon commissurotomy (PMBC) or mitral valve surgery, depending on the patient's condition.

Degree of leaflet thickening, calcification, mobility, and extent of subvalvular thickening.

A 50% reduction in the mean mitral valve gradient and a doubling of the mitral valve area.

Malar flush, prominent 'a' waves in jugular venous pulse, diastolic thrill at the cardiac apex, and a diastolic rumbling murmur.

It is not recommended unless there is recurrent systemic embolization or severe pulmonary hypertension.

Approximately 2%.

Age, left ventricular function, presence of coronary artery disease, and associated comorbidities.

About two decades.