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.
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.
TABLE 20-1MAJOR CAUSES OF VALVULAR HEART DISEASES |Favorite Table|Download (.pdf) TABLE 20-1MAJOR CAUSES OF VALVULAR HEART DISEASES
|VALVE LESION ||ETIOLOGIES ||VALVE LESION ||ETIOLOGIES |
Severe mitral annular calcification
Papillary muscle rupture (post-MI)
Chordal rupture/leaflet flail (MVP, IE)
Mitral annular calcification
Congenital (cleft, AV canal)
HOCM with SAM
Ischemic (LV remodeling)
Congenital (bicuspid, unicuspid)
Cystic medial degeneration
Bicuspid aortic valve
Nonsyndromic familial aneurysm
Papillary muscle injury (post-MI)
RV and tricuspid annular dilatation
Multiple causes of RV enlargement (e.g., long-standing pulmonary HTN)
Chronic RV apical pacing
In rheumatic MS, the valve leaflets ...