Materiały źródłowe

• #1 Mitral Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430742/

  Mitral stenosis (MS) is a form of valvular heart disease characterized by the narrowing of the mitral valve orifice. […] The most common cause of mitral stenosis is rheumatic fever, though the stenosis typically does not become clinically relevant until several decades later. […] Mitral valve areas less than 2 square centimeters cause an impediment to the blood flow from the left atrium into the left ventricle. This creates a pressure gradient across the mitral valve. […] Mitral stenosis causes an increase in left atrial pressure. […] As left atrial pressure remains elevated, the left atrium will increase in size. […] Thus, the left ventricular filling depends on the atrial kick in severe mitral stenosis. […] Mitral stenosis progresses slowly from initial signs of mitral stenosis to NYHA functional class II symptoms to atrial fibrillation to NYHA functional class III or IV symptoms.

• #1 Mitral Stenosis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/897204-overview

  Mitral stenosis (MS) is characterized by obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve apparatus. The most common cause of mitral stenosis is rheumatic fever. […] Stenosis of the mitral valve typically occurs decades after the episode of acute rheumatic carditis. Acute insult leads to formation of multiple inflammatory foci (Aschoff bodies, perivascular mononuclear infiltrate) in the endocardium and myocardium. Small vegetations along the border of the valves may also be observed. With time, the valve apparatus becomes thickened, calcified, and contracted, and commissural adhesion occurs, ultimately resulting in stenosis. […] Whether the progression of valve damage is due to hemodynamic injury of the already affected valve apparatus or to the chronic inflammatory nature of the rheumatic process is unclear.

• #1 Mitral valve stenosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159

  Mitral valve stenosis, shown in the heart on the right, is a condition in which the heart’s mitral valve is narrowed. The valve doesn’t open properly, blocking blood flow coming into the left ventricle, the main pumping chamber of the heart. […] Mitral valve stenosis can be caused by a complication of strep throat called rheumatic fever. Rheumatic fever is now rare in the United States. […] In mitral valve stenosis, the valve opening narrows. The heart now must work harder to force blood through the smaller valve opening. Blood flow between the upper left and lower left heart chambers may decrease. […] Causes of mitral valve stenosis include: Rheumatic fever. This complication of strep throat is the most common cause of mitral valve stenosis. […] Calcium deposits. As you age, calcium deposits can build up around the mitral valve. This can cause narrowing of the structures that support the mitral valve flaps.

• #1 Mitral valve stenosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159

  Radiation therapy. This is a treatment for certain types of cancer. Radiation to the chest area can sometimes cause the mitral valve to thicken and harden. […] Heart condition present at birth, called a congenital heart defect. Rarely, some babies are born with a narrowed mitral valve. […] Other health conditions. Lupus and other autoimmune conditions may rarely cause mitral valve stenosis.

• #1 Mitral stenosis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000175.htm

  Rarely, other factors can cause mitral stenosis in adults. These include: Calcium deposits forming around the mitral valve, Radiation treatment to the chest, Some medicines. […] Children may be born with mitral stenosis (congenital) or other birth defects involving the heart that cause mitral stenosis. Often, there are other heart defects present along with the mitral stenosis. […] Mitral stenosis may run in families.

• #1

  https://journals.lww.com/mamc/fulltext/2015/01010/pathophysiology_of_mitral_valve_stenosis.8.aspx

  Mitral valve stenosis (MS) can be congenital or acquired. Congenital MS is mainly the consequence of abnormalities of the subvalvular apparatus and occurs mainly in infants and children. The congenital causes include parachute mitral valve deformity, congenital MS, supravalvular mitral ring and cor-triatriatum. The acquired causes of MS include rheumatic heart disease, left atrial (LA) myxoma, mitral annular calcification and thrombus formation. Rheumatic MS is the most common form encountered in the developing world. […] The rheumatic disease process causes contracture, scarring, and diffuse thickening and fibrosis of the leaflet tissue, fusion and fibrosis of the commissures and the subvalvular apparatus, and calcium deposition within the leaflets. These processes result in a decrease in the effective mitral valve orifice area (MVA) and manifestation of clinical features of MS. The main mechanism of rheumatic MS is commissural fusion. Other lesions such as chordal shortening and fusion, leaflet thickening and its calcification contribute to the restriction of leaflet motion.

• #1 Mitral valve stenosis: epidemiology and causes in elderly patients

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients

  Mitral stenosis is a haemodynamic obstruction at the level of the mitral valve which involves an increased resistance to the transmitral flow. This obstruction is due to a modification in the physiological shape, thickness and mobility of the mitral leaflets. […] The second cause of mitral stenosis in the elderly is mitral annular calcification. Currently, this anatomopathological condition is rarely considered a cause of left ventricular inflow obstruction and is underestimated. Mitral annular calcification consists in the progressive deposition of calcium above and below the valvular fibrous ring causing a reduction of leaflet mobility and therefore a hindrance to physiological diastolic annular dilation. […] Calcification at the level of the mitral annulus can determine haemodynamically significant obstruction due to the impairment of physiological diastolic annular dilatation and the reduction of leaflet motion.

• #1

  https://journals.lww.com/mamc/fulltext/2015/01010/pathophysiology_of_mitral_valve_stenosis.8.aspx

  In degenerative MS, commissural fusion is rare, and the valve thickening or calcification predominates at the base of the leaflets whereas in rheumatic MS, the tips are predominantly affected. Protruding calcification, reduction of normal mitral annular dilatation during diastole and impaired anterior mitral leaflet mobility, are possible mechanisms responsible for the increased mitral gradient caused by mitral annular calcification. […] The normal MVA is approximately 4-6 cm2. The shape of the pressure-volume loop in the presence of MS is normal; however, the area of the loop and the end diastolic volume are significantly decreased. As the MVA decreases below 1.5 cm2, the symptoms of MS appear, and at a MVA below 1 cm2 (severe MS) patients usually become symptomatic even at rest. In patients with severe MS, a substantial increase in LA pressure and a gradient across the MV develops to accomplish left ventricular (LV) filling. The increased LA pressure passively elevates pulmonary venous and pulmonary capillary pressure and causes symptoms of pulmonary congestion.

• #1 Mitral valve stenosis: epidemiology and causes in elderly patients

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Mitral-valve-stenosis-epidemiology-and-causes-in-elderly-patients

  Because this process has a common basis with aortic calcifications and atherosclerosis, it also shares the inflammatory component in addition to cardiovascular risk factors. Studies have identified some actors of this mechanism in the low levels of the multifunctional fetuin-A glycoprotein, which deals with the inhibition of calcific degeneration, in the fibroblast growth factor, and in the presence of high values of inflammation markers. […] Among the promoters of the development of mitral annular calcification, disorders of tissue mineralisation play a key role that is particularly evident in elderly patients with chronic kidney disease and even more in those on dialysis. In this context, the calcification degeneration is supported by an increase in phosphorus-calcium product, hypercalcaemia, hyperphosphataemia and then secondary hyperparathyroidism. […] Calcium thickness is a strong predictor of risk for myocardial infarction and vascular death and increases in significance progressively with advancing age and gravity of calcification.

• #1 Mitral stenosis – Wikipedia

  https://en.wikipedia.org/wiki/Mitral_stenosis

  Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during diastole. Any decrease in area below 2 cm2 causes mitral stenosis. […] When the mitral valve area goes below 2 cm2, the valve causes an impediment to the flow of blood into the left ventricle, creating a pressure gradient across the mitral valve. This gradient may be increased by increases in the heart rate or cardiac output. As the gradient across the mitral valve increases, the amount of time necessary to fill the left ventricle with blood increases. Eventually, the left ventricle requires the atrial kick to fill with blood. […] When the mitral valve area goes less than 1 cm2, there will be an increase in the left atrial pressures (required to push blood through the stenotic valve).

• #1 Mitral Stenosis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/897204-overview

  Severe mitral stenosis occurs with a valve area of less than 1 cm2. As the valve progressively narrows, the resting diastolic mitral valve gradient, and hence left atrial pressure, increases. This leads to transudation of fluid into the lung interstitium and dyspnea at rest or with minimal exertion. Hemoptysis may occur if the bronchial veins rupture and left atrial dilatation increases the risk for atrial fibrillation and subsequent thromboembolism. […] Pulmonary hypertension may develop as a result of (1) retrograde transmission of left atrial pressure, (2) pulmonary arteriolar constriction, (3) interstitial edema, or (4) obliterative changes in the pulmonary vascular bed (intimal hyperplasia and medial hypertrophy). […] Approximately one third of patients with rheumatic mitral stenosis have depressed left ventricular systolic function as a result of chronic rheumatic myocarditis.

• #1 CV Physiology | Valvular Stenosis

  https://cvphysiology.com/heart-disease/hd004

  Mitral valve stenosis results from a narrowing of the opened mitral valve orifice so that it is more difficult for blood to flow from the left atrium (LA) into the left ventricle (LV) during ventricular diastole. […] The high resistance across the stenotic mitral valve causes blood to back up into the left atrium, increasing LA pressure, which in this example is 25 mmHg (normally ~10 mmHg). […] The left atrium enlarges (hypertrophies) over time because it has to generate higher than normal pressures when it contracts against the high resistance of the stenotic valve. […] Mitral valve stenosis is associated with a diastolic murmur because of turbulence that occurs as blood flows across the stenotic valve. […] The gradient is highest during early diastole, when the flow across the valve is highest. […] The increase in LA pressure can cause pulmonary congestion and edema because of increased pulmonary capillary hydrostatic pressure.

• #1 Mitral stenosis – Wikipedia

  https://en.wikipedia.org/wiki/Mitral_stenosis

  The constant pressure overload of the left atrium will cause the left atrium to increase in size. As the left atrium increases in size, it becomes more prone to develop atrial fibrillation (AF). […] In individuals with severe mitral stenosis, the left ventricular filling is dependent on the atrial kick. The loss of the atrial kick due to atrial fibrillation can cause a precipitous decrease in cardiac output and sudden congestive heart failure. […] Patients with mitral stenosis prompts a series of hemodynamic changes that frequently cause deterioration of the patient’s clinical status. A reduction in cardiac output, associated with acceleration of heart rate and shortening of the diastolic time, frequently leads to congestive heart failure.

• #1 Mitral valve pathophysiology | PPT

  https://www.slideshare.net/slideshow/mitral-valve-pathophysiology/238011540

  MITRAL STENOSIS DEFINITION – MITRAL STENOSIS Narrowing of mitral valve orifice resulting in impedence of filling of left ventricle in diastole […] ETIOLOGY OF MITRAL STENOSIS Rheumatic fever Congenital Carcinoid Heart disease SLE Rheumatoid arthritis Extensive mitral annulus calcification […] Pathophysiology Impaired blood flow through mitral valve Elevated LA pressure Passively elevated pulmonary venous pressure Reactive pulmonary HTN (protection from lung congestion) Fixed pulmonary HTN (organic intimal medial changes) […] Pathophysiology Pulmonary HTN Right ventricular hypertrophy dilatation Tricuspid regurgitation (mostly functional) Right heart failure […] MITRAL STENOSIS AND LA 1. LA DILATATION 2. FIBROSIS OF THE ATRIAL WALL 3. DISORGANIZATION MUSCLE BUNDLES SUBSTRATE FOR ATRIAL FIBRILLATION BLOOD STASIS LARGE LA LOSS OF CONTRACTILITY CLOT

• #1

  https://journals.lww.com/mamc/fulltext/2015/01010/pathophysiology_of_mitral_valve_stenosis.8.aspx

  PAH in MS is benign and mechanical in the beginning and develops as a compensatory mechanism to overcome resistance offered by MS; later, it progresses secondary to pulmonary arteriolar constriction and pulmonary arteriolar obliteration. However, in a given patient it is not possible to know the contribution of each of these factors in the genesis of PAH. […] Based on this hypothesis, it is apparent that clinical situations that result in decreased RV performance/decompensation would result in low cardiac output whereas situations where RV performance remains unaffected or increases in response to pathophysiological stimulation might result in increased LA pressure, pulmonary congestion, edema, but sustained cardiac output.

• #1 Mitral valve stenosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/mitral-valve-stenosis-1?lang=us

  However, this adaptive mechanism eventually fails because as the left atrial pressure continues to increase as the stenosis worsens, the amount of time needed to fill the left ventricle with blood also increases 2,3. This can be compounded by atrial fibrillation, a complication of left atrial enlargement, which results in the loss of the 'atrial kick’ at the end of diastole and an even greater left atrial pressure being needed 2,3. […] This becomes particularly problematic if there is an increase in heart rate (i.e. aforementioned precipitants) because the diastolic period shortens more than the systolic period 2,3. This means there is even less time to fill the left ventricle, often resulting in a sudden drop in cardiac output and development of acute pulmonary edema 2,3.

• #1 Mitral Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430742/

  Mitral stenosis is evaluated using noninvasive and invasive measures. […] An echocardiogram is useful for assessing mitral stenosis etiology, morphology, severity, and treatment intervention. […] Treatment for mitral stenosis involves medical therapy, percutaneous mitral valvuloplasty, and surgical therapy. […] Mitral valve replacement surgery is indicated in patients with symptomatic moderate or severe mitral stenosis when percutaneous mitral balloon valvuloplasty is contraindicated or unfavorable valve morphology. […] Mitral valve stenosis can remain asymptomatic for years, especially when resulting from rheumatic fever. […] Once symptoms become apparent, the progression of the disease generally accelerates, particularly when it is secondary to rheumatic fever.

• #1 Mitral stenosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Mitral_stenosis_pathophysiology

  The valve problems develop 5 – 10 years after the rheumatic fever, a tiny nodule forms along the valve leaflets, the leaflets eventually thicken with deposition of fibrin. The cusps may become fibrosed, calcified and thickened over a span of a decade. Chronic turbulent flow through a deformed valve appears to cause these changes and as a result the valve loses its normal morphology. […] The degree of leaflet thickening and calcification and the severity of chordal involvement are variable. Rheumatic fever is becoming rare in the United States, so mitral stenosis is also less common. […] The severity of mitral stenosis depends on the pressure gradient between the left atrium and ventricle which depends on the cross sectional area of the mitral valve. […] Usually, the rate of decrement in the valve area is about 0.1 cm2/year once mitral stenosis is present.

• #1 Mitral Stenosis – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/valvular-disorders/mitral-stenosis

  LA enlargement predisposes to atrial fibrillation (AFib), a risk factor for thromboembolism. […] Symptoms of mitral stenosis correlate poorly with disease severity because the disease often progresses slowly, and patients unconsciously reduce their activity. […] The natural history of mitral stenosis varies, but the interval between onset of symptoms and severe disability is about 7 to 9 years. Outcome is affected by the patients preprocedural age and functional status, presence of pulmonary hypertension, and degree of mitral regurgitation.

• #1 Mitral stenosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Mitral_stenosis_pathophysiology

  Mitral stenosis occurs when the orifice area is reduced to at least 2.2 cm2. This degree of narrowing results in a gradient across the mitral valve. […] When the mitral valve area goes below 2 cm2, the valve causes an impediment to the flow of blood into the left ventricle, creating a pressure gradient across the mitral valve. […] When the mitral valve area goes less than 1 cm2, there will be a further increase in the left atrial pressures. […] The elevated pressures in the left atrium are transmitted into the pulmonary circuit, and pulmonary hypertension may develop. […] The elevated pulmonary capillary wedge pressure leads to a rise in interstitial edema which also increases the load on the right ventricle. […] All the aforementioned changes lead to a rise in the pulmonary arterial pressure and the right ventricle begins to dilate and fail. […] A chronic smouldering rheumatic myocarditis may further reduce left ventricular function. […] In pregnancy, the pressure gradient between the left atrium and ventricle is usually increased due to the increase in the heart rate and cardiac output during pregnancy.

• #1 Pathophysiology and natural history of mitral stenosis – UpToDate

  https://www.uptodate.com/contents/pathophysiology-and-natural-history-of-mitral-stenosis

  The hemodynamic consequence of mitral stenosis (MS) is an increased impedance or resistance to transmitral flow. MS attenuates the atrial contribution to left ventricular filling and it also poses a hydraulic opposition or resistance to early filling. […] Rheumatic heart disease (RHD) is the most common cause of mitral stenosis (MS); other causes are much less frequent. However, only 50 to 70 percent of patients with MS report a history of rheumatic fever. RHD remains a major public health problem in resource-limited countries. Rheumatic MS has become less common in resource-rich countries given marked reductions in the incidence of rheumatic fever. Occasional outbreaks of rheumatic fever in the United States appear to be the result of either increased virulence of a streptococcal strain or immigration from areas where RHD is prevalent. Involvement of the mitral valve is present in approximately 90 percent of individuals with RHD. Since rheumatic MS is a chronic condition, it is not seen during the first episode of acute rheumatic carditis. In many populations, RHD is more common in females than in males. Rheumatic MS is a continuously progressive lifelong disease.

• #1 Mitral Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/mitral-stenosis

  Over time, as mitral stenosis worsens and the mitral valve area decreases, right heart pressures increase to maintain cardiac output across the stenotic valve with a pressure gradient between the left atrium and the left ventricle. On exertion, with increases in cardiac output and increased flow through the mitral valve, the pressure gradient becomes exponentially larger, and pulmonary edema can occur. […] Thus, if the velocity (V) of flow is doubled, the transmitral pressure gradient increases by a factor of four. The resultant large increase in pulmonary and LA pressures is responsible for the exertional symptoms seen in mitral stenosis.

• #1 Mitral valve pathophysiology | PPT

  https://www.slideshare.net/slideshow/mitral-valve-pathophysiology/238011540

  PULMONARY ARTERY HYPERTENSION This pulmonary hypertension in MS has THREE components: 1. Passive transmission of LA pressure 2. Reactive pulmonary artery hypertension 3. Potentially Fixed resistance, secondary to morphologic changes in the pulmonary vasculature […] Mitral stenosis – Symptoms MC:FATIGUE AND DECREASED EXERCISE INTOLERANCE Dyspnea Orthopnea PND (atypical) Hemoptysis Palpitations Hoarseness (Ortner syndrome) Chest pain (atypical) THROMBOEMBOLISM,IE – relatively rare […] Mitral stenosis Late symptoms PHT, TR, right CHF: Easy fatigability Hepatic congestion Ascites Lower limb edema […] PATHOPHYSIOLOGY ACUTE PHASE INFLAMMATION AND EDEMA FIBRIN DEPOSITS CHRONIC PHASE (HEALING PHASE) LEAFLET THICKENING MAXIMAL AT EDGES SYMMETRICAL COMMISSURAL FUSION CHORDAL SHORTENING/FUSION PAPILLARY MUSCLE FUSION CALCIFICATIONSCARRINGNON PLIABLE,STIFF LEAFLETS / SVD

• #1 Pathophysiology of Mitral Valve Disease | Thoracic Key

  https://thoracickey.com/pathophysiology-of-mitral-valve-disease/

  Mitral stenosis generally is the result of rheumatic heart disease. Nonrheumatic causes of mitral stenosis or LV inflow obstruction include severe mitral annular and/or leaflet calcification in the elderly, congenital mitral valve deformities, malignant carcinoid syndrome, neoplasm, LA thrombus, endocarditic vegetations, certain inherited metabolic diseases, and those cases related to previous commissurotomy or an implanted prosthesis. A definite history of rheumatic fever can be obtained in only about 50 to 60% of patients; women are affected more often than men by a 2:1 to 3:1 ratio. Nearly always acquired before age 20, rheumatic valvular disease becomes clinically evident one to three decades later. […] The etiologic agent for acute rheumatic fever is group A beta-hemolytic streptococcus, but the specific immunologic and inflammatory mechanisms leading to the valvulitis are less clear. Streptococcal antigens cross react with human tissues, known as molecular mimicry, and may stimulate immunologic responses. Components implicated in the organisms virulence include the hyaluronic acid capsule and the antigenic streptococcal M-protein and its peptides.

• #1 Pathophysiology of Mitral Valve Disease | Thoracic Key

  https://thoracickey.com/pathophysiology-of-mitral-valve-disease/

  In acute rheumatic fever and rheumatic heart disease, M-protein can cross react with cardiac myosin, which induces T-cell-mediated injury of cardiac tissue and valves. […] In addition to valvular involvement, rheumatic heart disease is a pancarditis affecting to various degrees the endocardium, myocardium, and pericardium. In rheumatic valvulitis, mitral valve involvement is the most common (isolated mitral stenosis is found in 40% of patients), followed by combined aortic and mitral valve disease, and least frequently, isolated aortic valve disease. Pathoanatomical characteristics of mitral valvulitis include commissural fusion, leaflet fibrosis with stiffening and retraction, and chordal fusion and shortening. Leaflet stiffening and fibrosis can be exacerbated over time by increased flow turbulence.

• #1 Mitral Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/mitral-stenosis

  The typical normal adult mitral valve area is between 4 and 5 cm2. […] When any disease process decreases the mitral valve area, mitral stenosis (MS) develops. As mitral stenosis progresses, increased left atrial pressure is required to maintain stroke volume. This pressure increase is generated primarily by the right heart and results in increased pulmonary arterial and venous pressures that are responsible for nearly all of the clinical manifestations of mitral stenosis. […] In rheumatic heart disease, autoimmune inflammation involving the mitral valve produces thickening of the valve leaflets and commissural fusion. The mitral valve is often described as having a fish-mouth appearance. Whether the worsening of mitral stenosis over time is secondary to a smoldering rheumatic process or simply progressive mitral valve damage due to high pressures and turbulence is unknown; both most likely contribute to the slowly progressive process of mitral stenosis.

• #1 Pathology Outlines – Degenerative valve disease

  https://www.pathologyoutlines.com/topic/heartdegenerative.html

  In degenerative mitral stenosis, calcific deposits develop in the peripheral fibrous ring (annulus), which are stony hard, irregular ulcerated nodules which appear behind the leaflets […] Over time, the chordae tendineae become thinner and rupture, leaving the annulus dilated; this rupture allows the valves to become floppy and prolapse into the atrium during systole.

• #1

  https://www.jaypeedigital.com/eReader/chapter/9789352701926/ch5

  This chapter discusses pathophysiology, natural history and hemodynamics of mitral stenosis. Rheumatic fever and RHD is sequelae of beta hemolytic streptococcal throat infection triggering an autoimmune reaction in the human body. The autoimmune response is both cell and humoral immunity mediated. The orifice area of normal mitral valve is about 46 cm2. The chronic rheumatic activity results in one or more of the following pathological processes after a variable latent period: fusion of commissures, thickening, fibrosis, retraction of edges of valve leaflets, calcification of leaflet tissue, and shortening, thickening and fusion of chordae. These pathological processes results in a funnel-shaped mitral apparatus in which the orifice of the mitral opening is narrowed. In response to the chronic hemodynamic effects of MS, remodeling occurs in left atrium (LA) and left ventricle (LV). This remodeling affects not only the clinical features of MS, but also influences the cardiac output and the pressure wave forms.

• #1

  https://journals.lww.com/mamc/fulltext/2015/01010/pathophysiology_of_mitral_valve_stenosis.8.aspx

  Increased pressure and distension of the pulmonary veins and capillaries can lead to pulmonary edema as pulmonary venous pressure exceeds that of plasma oncotic pressure. In patients with chronic MV obstruction, however, even when it is severe and pulmonary venous pressure is very high, pulmonary edema may not occur owing to a marked decrease in pulmonary microvascular permeability. […] PAH in MS is considered a sequel of increased LA pressure, reflex protective pulmonary arteriolar constriction, intimal hyperplasia, medial hypertrophy, and pulmonary arteriolar obliteration. A close scrutiny of reasons of increased LA pressure is necessary to understand the genesis of PAH. […] For the increase in LA pressure to be substantial that develops in severe MS, the compliance of LA and pulmonary venous system should be low else the effect of damming of blood will dissipate in LA and pulmonary vascular bed and a substantial increase in LA pressure will not occur.

• #1 Valvular heart disease: Types and presentation | Kenhub

  https://www.kenhub.com/en/library/anatomy/valvular-heart-disease

  While the mitral valve may remain functional in the presence of annular calcification, there are cases where stone-like, ulcerated, irregular nodules may impede valve opening. Additionally, the nodules may burrow into the endocardium and disrupt the atrioventricular node and its associated system. Also, due to the irregularity of the nodules, they can act as a nidus for thrombus development and infective endocarditis.

• #1 Unrecognised mitral valve stenosis in a London multi-ethnic community – The British Journal of Cardiology

  https://bjcardio.co.uk/2011/06/unrecognised-mitral-valve-stenosis-in-a-london-multi-ethnic-community/

  Early diagnosis of mitral valve stenosis using echocardiography is the only way to identify cases of rheumatic mitral valve disease at an early stage and allow the appropriate management, irrespective of patients ethnicity. […] Similar to other previous reports, our findings have confirmed the value of echocardiography and Doppler ultrasound in identifying rheumatic carditis in the absence of clinical signs and/or symptoms. […] Atrial fibrillation, which first appears in its paroxysmal form then becomes persistent, constitutes the most common complication of mitral valve stenosis. […] Though rheumatic fever is the leading cause of mitral valve stenosis, none of our patients reported a history of rheumatic fever, although rheumatic changes were noticed on the mitral valves in all eight of the patients in our study. […] The absence of a history of rheumatic fever in a subject does not preclude the presence of rheumatic heart disease. […] Regular follow-up of such patients is necessary in order to assess the progress of the mitral stenosis and to diagnose atrial fibrillation early.

• #1 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/

  Mitral stenosis is a relatively common disorder, which, if left untreated, is associated with high morbidity and mortality. Mitral stenosis rates had decreased in the US 4 decades ago, but with the mass migration of individuals from other countries, a resurgence of cases has been observed. The number one cause for most cases of mitral stenosis is rheumatic fever. The key is to prevent the valvular disorder by ensuring that patients with strep throat are adequately treated.

• #1 Mitral Stenosis | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602423/all/Mitral_Stenosis

  Mitral stenosis (MS) is characterized by incomplete opening of the mitral valve during diastole, which limits antegrade flow and yields a sustained diastolic pressure gradient between the left atrium (LA) and the left ventricle (LV). […] Rheumatic fever can cause fibrosis, thickening, and calcification, leading to fusion of the commissures, leaflets, chordae, and/or papillary muscles. […] MS causes increased pressure in the LA, which then dilates as a compensatory mechanism. This causes the LA to dilate and fibrose, which then leads to atrial arrhythmias and thrombus formation. […] A sustained increase in pulmonary venous pressures is transmitted backward to cause pulmonary hypertension (PH) and with time, increased pulmonary vascular resistance and right ventricular pressure overload and dysfunction.

• #1 Mitral Valve Stenosis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21903-mitral-valve-stenosis

  Present at birth. Providers usually detect congenital (present at birth) mitral stenosis before the age of 2. This kind of stenosis can range from mild to severe. If not treated, children with severe mitral stenosis typically dont survive past age 5. […] The best outcomes from mitral valve stenosis happen with early detection and timely treatment. Because mitral valve stenosis usually causes a heart murmur, your healthcare provider can often catch it when they listen to your heart during an annual physical exam or checkup. This can help detect and treat it before it becomes severe or advanced.

• #1 Mitral Valve Stenosis Causes, Symptoms & Treatment

  https://www.thekeyholeheartclinic.com/services/valve-disorders/mitral-valve2/mitral-stenosis/

  Once the mitral valve has become narrowed and calcified, it is unlikely that it will fix itself. This is typically a lifelong disease that progresses over time. In the early stages, you may experience mild symptoms or no symptoms at all, but as it progresses, the left atrium may become more damaged, causing more severe symptoms. While the mild symptoms may be able to be managed with certain drugs and monitoring, the best course of action for the later stages is keyhole heart surgery.

• #2 Mitral Stenosis: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/897204-overview

  Mitral stenosis (MS) is characterized by obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve apparatus. The most common cause of mitral stenosis is rheumatic fever. […] Stenosis of the mitral valve typically occurs decades after the episode of acute rheumatic carditis. Acute insult leads to formation of multiple inflammatory foci (Aschoff bodies, perivascular mononuclear infiltrate) in the endocardium and myocardium. Small vegetations along the border of the valves may also be observed. With time, the valve apparatus becomes thickened, calcified, and contracted, and commissural adhesion occurs, ultimately resulting in stenosis. […] Whether the progression of valve damage is due to hemodynamic injury of the already affected valve apparatus or to the chronic inflammatory nature of the rheumatic process is unclear.

• #2 Mitral Stenosis (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK568793/

  Mitral stenosis (MS) is a form of valvular heart disease. Mitral stenosis is characterized by narrowing of the mitral valve orifice. Today, the most common cause of mitral stenosis is rheumatic fever, but the stenosis usually appears clinically relevant only after several decades. […] The most common cause of mitral stenosis is rheumatic fever. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endomyocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis. […] Mitral stenosis presents 20 to 40 years after an episode of rheumatic fever. The most common symptoms are orthopnea and paroxysmal nocturnal dyspnea.

• #2 Mitral valve stenosis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/mitral-valve-stenosis

  Mitral valve stenosis sometimes called mitral stenosis is a narrowing of the valve between the two left heart chambers. The narrowed valve reduces or blocks blood flow into the lower left heart chamber. The heart now must work harder to force blood through the smaller valve opening. Blood flow between the upper left and lower left heart chambers may decrease. […] In mitral valve stenosis, the valve opening narrows. […] Causes of mitral valve stenosis include: Rheumatic fever. This complication of strep throat is the most common cause of mitral valve stenosis. When rheumatic fever damages the mitral valve, the condition is called rheumatic mitral valve disease. […] Calcium deposits. As you age, calcium deposits can build up around the mitral valve. This can cause narrowing of the structures that support the mitral valve flaps. The condition is called mitral annular calcification, or MAC for short. Severe MAC can cause mitral stenosis symptoms.

• #2 Mitral valve stenosis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/mitral-valve-stenosis

  Radiation therapy. This is a treatment for certain types of cancer. Radiation to the chest area can sometimes cause the mitral valve to thicken and harden. […] Heart condition present at birth, called a congenital heart defect. Rarely, some babies are born with a narrowed mitral valve. […] Other health conditions. Lupus and other autoimmune conditions may rarely cause mitral valve stenosis. […] Mitral valve stenosis that is not treated can lead to complications such as: Irregular heartbeats. Irregular heartbeats are called arrhythmias. Mitral valve stenosis may cause an irregular and chaotic heart rhythm called atrial fibrillation. […] High blood pressure in the lung arteries. The medical name for this condition is pulmonary hypertension. It can happen if a narrowed mitral valve slows or blocks blood flow.

• #2 Pathophysiology of Mitral Valve Disease | Thoracic Key

  https://thoracickey.com/pathophysiology-of-mitral-valve-disease/

  Mitral stenosis generally is the result of rheumatic heart disease. Nonrheumatic causes of mitral stenosis or LV inflow obstruction include severe mitral annular and/or leaflet calcification in the elderly, congenital mitral valve deformities, malignant carcinoid syndrome, neoplasm, LA thrombus, endocarditic vegetations, certain inherited metabolic diseases, and those cases related to previous commissurotomy or an implanted prosthesis. A definite history of rheumatic fever can be obtained in only about 50 to 60% of patients; women are affected more often than men by a 2:1 to 3:1 ratio. Nearly always acquired before age 20, rheumatic valvular disease becomes clinically evident one to three decades later. […] The etiologic agent for acute rheumatic fever is group A beta-hemolytic streptococcus, but the specific immunologic and inflammatory mechanisms leading to the valvulitis are less clear. Streptococcal antigens cross react with human tissues, known as molecular mimicry, and may stimulate immunologic responses. Components implicated in the organisms virulence include the hyaluronic acid capsule and the antigenic streptococcal M-protein and its peptides.

• #2

  https://journals.lww.com/mamc/fulltext/2015/01010/pathophysiology_of_mitral_valve_stenosis.8.aspx

  Mitral valve stenosis (MS) can be congenital or acquired. Congenital MS is mainly the consequence of abnormalities of the subvalvular apparatus and occurs mainly in infants and children. The congenital causes include parachute mitral valve deformity, congenital MS, supravalvular mitral ring and cor-triatriatum. The acquired causes of MS include rheumatic heart disease, left atrial (LA) myxoma, mitral annular calcification and thrombus formation. Rheumatic MS is the most common form encountered in the developing world. […] The rheumatic disease process causes contracture, scarring, and diffuse thickening and fibrosis of the leaflet tissue, fusion and fibrosis of the commissures and the subvalvular apparatus, and calcium deposition within the leaflets. These processes result in a decrease in the effective mitral valve orifice area (MVA) and manifestation of clinical features of MS. The main mechanism of rheumatic MS is commissural fusion. Other lesions such as chordal shortening and fusion, leaflet thickening and its calcification contribute to the restriction of leaflet motion.

• #2 Aetiology and epidemiology of mitral stenosis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Aetiology-and-epidemiology-of-mitral-stenosis

  Mitral stenosis (MS) is characterised by a narrowed valve orifice and obstruction to left ventricular inflow. Rheumatic MS, a delayed complication of rheumatic fever, is the most common aetiology for MS worldwide, while degenerative MS due to mitral annular calcification (MAC) is increasingly encountered in developed countries. […] Mitral stenosis most commonly occurs because of rheumatic fever or degenerative MV disease. Although rheumatic fever remains the predominant cause of MS worldwide, it has been largely replaced by degenerative MS in the developed countries. […] The hallmark feature of rheumatic MS is commissural fusion which eventually leads to the classic fish mouth appearance of the valve orifice. Other anatomical lesions include chordal shortening and fusion, leaflet thickening and, later in the disease, superimposed calcification which may contribute to the restriction of leaflet motion. However, unlike annular involvement in degenerative MS, calcification in rheumatic MS primarily affects the leaflet tips.

• #2 Mitral Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/mitral-stenosis

  The typical normal adult mitral valve area is between 4 and 5 cm2. […] When any disease process decreases the mitral valve area, mitral stenosis (MS) develops. As mitral stenosis progresses, increased left atrial pressure is required to maintain stroke volume. This pressure increase is generated primarily by the right heart and results in increased pulmonary arterial and venous pressures that are responsible for nearly all of the clinical manifestations of mitral stenosis. […] In rheumatic heart disease, autoimmune inflammation involving the mitral valve produces thickening of the valve leaflets and commissural fusion. The mitral valve is often described as having a fish-mouth appearance. Whether the worsening of mitral stenosis over time is secondary to a smoldering rheumatic process or simply progressive mitral valve damage due to high pressures and turbulence is unknown; both most likely contribute to the slowly progressive process of mitral stenosis.

• #2

  https://journals.lww.com/mamc/fulltext/2015/01010/pathophysiology_of_mitral_valve_stenosis.8.aspx

  In degenerative MS, commissural fusion is rare, and the valve thickening or calcification predominates at the base of the leaflets whereas in rheumatic MS, the tips are predominantly affected. Protruding calcification, reduction of normal mitral annular dilatation during diastole and impaired anterior mitral leaflet mobility, are possible mechanisms responsible for the increased mitral gradient caused by mitral annular calcification. […] The normal MVA is approximately 4-6 cm2. The shape of the pressure-volume loop in the presence of MS is normal; however, the area of the loop and the end diastolic volume are significantly decreased. As the MVA decreases below 1.5 cm2, the symptoms of MS appear, and at a MVA below 1 cm2 (severe MS) patients usually become symptomatic even at rest. In patients with severe MS, a substantial increase in LA pressure and a gradient across the MV develops to accomplish left ventricular (LV) filling. The increased LA pressure passively elevates pulmonary venous and pulmonary capillary pressure and causes symptoms of pulmonary congestion.

• #2 Mitral valve stenosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/mitral-valve-stenosis-1?lang=us

  Mitral stenosis is usually acquired via rheumatic heart disease, where there is chronic inflammation of the mitral valve leaflets (mitral valvulitis) 2,3. This leads to progressive and diffuse fibrous thickening of the valve leaflets, and development of valvular calcifications 2,3. Eventually, the mitral commisures fuse and the chordae tendinae fuse 2,3. This culminates in significant immobilization and narrowing of the mitral valve, giving it a characteristic 'fish mouth’ appearance 2-4. […] The characteristic hemodynamic feature of mitral stenosis is an increased left atrial pressure 2,3. This increase in pressure is required as a compensatory mechanism for the stenosis, in order to maintain normal cardiac output 2,3. However, this compensation results in left atrial enlargement and an increase in pulmonary venous pressure 2,3. An increase in pulmonary venous pressure eventually leads to the development of pulmonary arterial hypertension, explaining why dyspnea and hemoptysis are such prominent and important symptoms in mitral stenosis 2,3.

• #2 Mitral Stenosis – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/valvular-disorders/mitral-stenosis

  LA enlargement predisposes to atrial fibrillation (AFib), a risk factor for thromboembolism. […] Symptoms of mitral stenosis correlate poorly with disease severity because the disease often progresses slowly, and patients unconsciously reduce their activity. […] The natural history of mitral stenosis varies, but the interval between onset of symptoms and severe disability is about 7 to 9 years. Outcome is affected by the patients preprocedural age and functional status, presence of pulmonary hypertension, and degree of mitral regurgitation.

• #2 CV Physiology | Valvular Stenosis

  https://cvphysiology.com/heart-disease/hd004

  Mitral valve stenosis results from a narrowing of the opened mitral valve orifice so that it is more difficult for blood to flow from the left atrium (LA) into the left ventricle (LV) during ventricular diastole. […] The high resistance across the stenotic mitral valve causes blood to back up into the left atrium, increasing LA pressure, which in this example is 25 mmHg (normally ~10 mmHg). […] The left atrium enlarges (hypertrophies) over time because it has to generate higher than normal pressures when it contracts against the high resistance of the stenotic valve. […] Mitral valve stenosis is associated with a diastolic murmur because of turbulence that occurs as blood flows across the stenotic valve. […] The gradient is highest during early diastole, when the flow across the valve is highest. […] The increase in LA pressure can cause pulmonary congestion and edema because of increased pulmonary capillary hydrostatic pressure.

• #2

  https://journals.lww.com/mamc/fulltext/2015/01010/pathophysiology_of_mitral_valve_stenosis.8.aspx

  Increased pressure and distension of the pulmonary veins and capillaries can lead to pulmonary edema as pulmonary venous pressure exceeds that of plasma oncotic pressure. In patients with chronic MV obstruction, however, even when it is severe and pulmonary venous pressure is very high, pulmonary edema may not occur owing to a marked decrease in pulmonary microvascular permeability. […] PAH in MS is considered a sequel of increased LA pressure, reflex protective pulmonary arteriolar constriction, intimal hyperplasia, medial hypertrophy, and pulmonary arteriolar obliteration. A close scrutiny of reasons of increased LA pressure is necessary to understand the genesis of PAH. […] For the increase in LA pressure to be substantial that develops in severe MS, the compliance of LA and pulmonary venous system should be low else the effect of damming of blood will dissipate in LA and pulmonary vascular bed and a substantial increase in LA pressure will not occur.

• #2 Mitral Stenosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430742/

  Mitral stenosis (MS) is a form of valvular heart disease characterized by the narrowing of the mitral valve orifice. […] The most common cause of mitral stenosis is rheumatic fever, though the stenosis typically does not become clinically relevant until several decades later. […] Mitral valve areas less than 2 square centimeters cause an impediment to the blood flow from the left atrium into the left ventricle. This creates a pressure gradient across the mitral valve. […] Mitral stenosis causes an increase in left atrial pressure. […] As left atrial pressure remains elevated, the left atrium will increase in size. […] Thus, the left ventricular filling depends on the atrial kick in severe mitral stenosis. […] Mitral stenosis progresses slowly from initial signs of mitral stenosis to NYHA functional class II symptoms to atrial fibrillation to NYHA functional class III or IV symptoms.

• #2 Mitral Stenosis Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/mitral-stenosis

  Over time, as mitral stenosis worsens and the mitral valve area decreases, right heart pressures increase to maintain cardiac output across the stenotic valve with a pressure gradient between the left atrium and the left ventricle. On exertion, with increases in cardiac output and increased flow through the mitral valve, the pressure gradient becomes exponentially larger, and pulmonary edema can occur. […] Thus, if the velocity (V) of flow is doubled, the transmitral pressure gradient increases by a factor of four. The resultant large increase in pulmonary and LA pressures is responsible for the exertional symptoms seen in mitral stenosis.

• #2 Mitral Stenosis | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602423/all/Mitral_Stenosis

  Mitral stenosis (MS) is characterized by incomplete opening of the mitral valve during diastole, which limits antegrade flow and yields a sustained diastolic pressure gradient between the left atrium (LA) and the left ventricle (LV). […] Rheumatic fever can cause fibrosis, thickening, and calcification, leading to fusion of the commissures, leaflets, chordae, and/or papillary muscles. […] MS causes increased pressure in the LA, which then dilates as a compensatory mechanism. This causes the LA to dilate and fibrose, which then leads to atrial arrhythmias and thrombus formation. […] A sustained increase in pulmonary venous pressures is transmitted backward to cause pulmonary hypertension (PH) and with time, increased pulmonary vascular resistance and right ventricular pressure overload and dysfunction.

• #2 Mitral valve pathophysiology | PPT

  https://www.slideshare.net/slideshow/mitral-valve-pathophysiology/238011540

  PULMONARY ARTERY HYPERTENSION This pulmonary hypertension in MS has THREE components: 1. Passive transmission of LA pressure 2. Reactive pulmonary artery hypertension 3. Potentially Fixed resistance, secondary to morphologic changes in the pulmonary vasculature […] Mitral stenosis – Symptoms MC:FATIGUE AND DECREASED EXERCISE INTOLERANCE Dyspnea Orthopnea PND (atypical) Hemoptysis Palpitations Hoarseness (Ortner syndrome) Chest pain (atypical) THROMBOEMBOLISM,IE – relatively rare […] Mitral stenosis Late symptoms PHT, TR, right CHF: Easy fatigability Hepatic congestion Ascites Lower limb edema […] PATHOPHYSIOLOGY ACUTE PHASE INFLAMMATION AND EDEMA FIBRIN DEPOSITS CHRONIC PHASE (HEALING PHASE) LEAFLET THICKENING MAXIMAL AT EDGES SYMMETRICAL COMMISSURAL FUSION CHORDAL SHORTENING/FUSION PAPILLARY MUSCLE FUSION CALCIFICATIONSCARRINGNON PLIABLE,STIFF LEAFLETS / SVD

• #2 Mitral Stenosis – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/heart-valve-disorders/mitral-stenosis

  Typically, when rheumatic fever is the cause of mitral stenosis, the mitral valve cusps are partially fused together. […] In some older adults, the valve instead degenerates and accumulates calcium deposits. […] Mitral stenosis can rarely be present at birth (congenital). […] Treatment, when needed, includes use of diuretics and beta-blockers or calcium channel blockers. […] If medication does not reduce the symptoms satisfactorily, the valve may be repaired (a procedure called valvuloplasty) or replaced. […] Often the valve can be stretched open using a procedure called balloon valvotomy. […] The rate of progression of mitral stenosis varies, but most people develop severe disability about 7 to 9 years after symptoms begin.

• #2 Pathophysiology of Mitral Valve Disease | Thoracic Key

  https://thoracickey.com/pathophysiology-of-mitral-valve-disease/

  In acute rheumatic fever and rheumatic heart disease, M-protein can cross react with cardiac myosin, which induces T-cell-mediated injury of cardiac tissue and valves. […] In addition to valvular involvement, rheumatic heart disease is a pancarditis affecting to various degrees the endocardium, myocardium, and pericardium. In rheumatic valvulitis, mitral valve involvement is the most common (isolated mitral stenosis is found in 40% of patients), followed by combined aortic and mitral valve disease, and least frequently, isolated aortic valve disease. Pathoanatomical characteristics of mitral valvulitis include commissural fusion, leaflet fibrosis with stiffening and retraction, and chordal fusion and shortening. Leaflet stiffening and fibrosis can be exacerbated over time by increased flow turbulence.

• #2 Mitral Valve Stenosis in Animals – Circulatory System – Merck Veterinary Manual

  https://www.merckvetmanual.com/circulatory-system/congenital-and-inherited-anomalies-of-the-cardiovascular-system/mitral-valve-stenosis-in-animals

  Mitral valve stenosis is a narrowing of the mitral valve orifice caused by abnormalities of the mitral valve, resulting in obstruction to left ventricular inflow. […] Mitral valve stenosis results in increased resistance to left atrial outflow, creating a pressure gradient between the left atrium and left ventricle. This leads to left atrial enlargement and increases in pulmonary venous and capillary wedge pressures. […] A pressure gradient is documented between the left atrium and left ventricle in early diastole.

• #2 Mitral Stenosis – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/mitral-valve-stenosis/

  Mitral stenosis (MS), also known as mitral valve stenosis, is a condition in which the opening between the left atrium and left ventricle of the heart, also known as the mitral valve orifice, is narrowed. This condition is a type of valvular heart disease. The narrowing of the mitral valve orifice can be caused by a number of issues, including infective endocarditis, mitral calcifications, congenital heart defects, and rheumatic heart disease. […] Rheumatic heart disease mitral stenosis is the most common type of mitral stenosis. Symptomatic MS typically presents 20 to 40 years after the initial episode of rheumatic fever due to recurrent acute carditis that occurs in these patients. In rheumatic heart disease, damage to the heart likely occurs because of a cross-reactive immune response that targets heart tissues while also targeting the streptococcal antigen that can be present during these infections.

• #2 Mitral Valve Stenosis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/mitral-stenosis

  If undetected or untreated, mitral valve stenosis can result in serious complications. The most common one is arrhythmia. Atrial fibrillation, in which the upper chambers of the heart tremble, will develop in many cases. […] Mitral valve stenosis also affects the lungs. Pulmonary edema, or fluid buildup, and pulmonary arterial hypertension may develop as a result of mitral valve stenosis.

• #2 Mitral stenosis – Wikipedia

  https://en.wikipedia.org/wiki/Mitral_stenosis

  The constant pressure overload of the left atrium will cause the left atrium to increase in size. As the left atrium increases in size, it becomes more prone to develop atrial fibrillation (AF). […] In individuals with severe mitral stenosis, the left ventricular filling is dependent on the atrial kick. The loss of the atrial kick due to atrial fibrillation can cause a precipitous decrease in cardiac output and sudden congestive heart failure. […] Patients with mitral stenosis prompts a series of hemodynamic changes that frequently cause deterioration of the patient’s clinical status. A reduction in cardiac output, associated with acceleration of heart rate and shortening of the diastolic time, frequently leads to congestive heart failure.

• #2 Mitral valve stenosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/mitral-valve-stenosis-1?embed_domain=hackmd.io%2525252F%25252540yipuafecsl2jsu8smr5njq%2525252Fbnjhjgjghjghjghradiopaedia-icon-144.png&lang=us

  However, this adaptive mechanism eventually fails because as the left atrial pressure continues to increase as the stenosis worsens, the amount of time needed to fill the left ventricle with blood also increases 2,3. This can be compounded by atrial fibrillation, a complication of left atrial enlargement, which results in the loss of the 'atrial kick’ at the end of diastole and an even greater left atrial pressure being needed 2,3. […] This becomes particularly problematic if there is an increase in heart rate (i.e. aforementioned precipitants) because the diastolic period shortens more than the systolic period 2,3. This means there is even less time to fill the left ventricle, often resulting in a sudden drop in cardiac output and development of acute pulmonary edema 2,3.

• #2 Mitral valve stenosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/mitral-valve-stenosis/

  Mitral valve stenosis obstruction of blood flow into the left ventricle (LV) limited diastolic filling of the LV (end-diastolic LV volume) decreased stroke volume decreased cardiac output (forward heart failure) […] Mitral valve stenosis increase in left atrial pressure backup of blood into lungs increased pulmonary capillary pressure cardiogenic pulmonary edema pulmonary hypertension backward heart failure and right ventricular hypertrophy.

• #3 Mitral stenosis – Wikipedia

  https://en.wikipedia.org/wiki/Mitral_stenosis

  Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during diastole. Any decrease in area below 2 cm2 causes mitral stenosis. […] When the mitral valve area goes below 2 cm2, the valve causes an impediment to the flow of blood into the left ventricle, creating a pressure gradient across the mitral valve. This gradient may be increased by increases in the heart rate or cardiac output. As the gradient across the mitral valve increases, the amount of time necessary to fill the left ventricle with blood increases. Eventually, the left ventricle requires the atrial kick to fill with blood. […] When the mitral valve area goes less than 1 cm2, there will be an increase in the left atrial pressures (required to push blood through the stenotic valve).

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