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INTRODUCTION

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The role of the physical examination in the evaluation of patients with valvular heart disease is also considered in Chaps. 9 and 10; of electrocardiography (ECG) in Chap. 11; of echocardiography and other noninvasive imaging techniques in Chap. 12; and of cardiac catheterization and angiography in Chap. 13.

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MITRAL STENOSIS

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ETIOLOGY AND PATHOLOGY

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Rheumatic fever is the leading cause of mitral stenosis (MS) (Table 20-1). Other less common etiologies of obstruction to left atrial outflow include congenital mitral valve stenosis, cor triatriatum, mitral annular calcification with extension onto the leaflets, systemic lupus erythematosus, rheumatoid arthritis, left atrial myxoma, and infective endocarditis with large vegetations. Pure or predominant MS occurs in approximately 40% of all patients with rheumatic heart disease and a history of rheumatic fever. In other patients with rheumatic heart disease, lesser degrees of MS may accompany mitral regurgitation (MR) and aortic valve disease. With reductions in the incidence of acute rheumatic fever, particularly in temperate climates and developed countries, the incidence of MS has declined considerably over the past few decades. However, it remains a major problem in developing nations, especially in tropical and semitropical climates.

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Table Graphic Jump Location
TABLE 20-1MAJOR CAUSES OF VALVULAR HEART DISEASES
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In rheumatic MS, the valve leaflets ...

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