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The natural history of mitral stenosis secondary to rheumatic fever (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years.
If mitral valve stenosis is a result of birth defects during development stemming from rheumatic fever, several things may occur in the heart. Rheumatic fever causes the immune system to attack its own protein tissues leading to lesions forming on the mitral valve flaps.
The American Heart Association recommends, based on low quality evidence but with high predicted efficacy, that people with mitral stenosis due to rheumatic heart disease receive prophylactic antibiotics for 10 years or until age 40, whichever would be longer. [49]
Symptoms of mitral stenosis increase with exercise and pregnancy [16] On auscultation of a patient with mitral stenosis, typically the most prominent sign is a loud S 1. [16] Another finding is an opening snap followed by a low-pitched diastolic rumble with presystolic accentuation.
Mitral regurgitation can also be caused by rheumatic fever, an inflammatory disease that can affect the heart tissue and lead to chronic rheumatic heart disease. The chronic inflammation leads to leaflet fibrosis, which makes it so that they don’t form a nice seal and instead let blood leak through.
With chronic rheumatic heart disease, the valves, typically the mitral valve but sometimes the aortic valve, develop scar tissue from repeated inflammation. The leaflets of the valves become thicker and can actually fuse together, called commissural fusion, Also the chordae tendinae which are attached to the valves can become thickened as well.
It is often associated with an S 3 gallop rhythm, and can be distinguished from the diastolic murmur of mitral stenosis by the absence of an opening snap before the murmur. It is audible at apex. The murmur is caused by increased blood flow across a thickened mitral valve. [1] The sign is named after Carey Coombs who was a British cardiologist.
Mitral stenosis causes left atrial pressure to increase, which, if left untreated, can lead to ventricular dilation, hypertrophy, atrial fibrillation, and thrombus creation. Symptoms include shortness of breath ( dyspnea ) on exertion, when lying flat ( orthopnea ) or during the night ( paroxysmal nocturnal dyspnea ), and fatigue.
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