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Chapter 50: Mitral Stenosis

Rheumatic heart disease (RHD) remains prevalent in developing countries. Which of the following statements about RHD in developing countries is false?

A. The prevalence ranges from 1 to 2 per 1000 school children

B. Ten percent of patients with RHD have isolated MS

C. Only 10% of patients with isolated MS report a past history of rheumatic fever

D. Symptoms occur after at least 4 decades from the initial attack of ARF

E. All of the above

The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 50) Using echocardiographic screening, the prevalence of RHD ranges from 20 to 30 per 1000 school children (option A is thus not correct).1,2 This leads to a large pool of rheumatic MS. Forty percent of patients with RHD have isolated MS (option B is thus not correct) but only 60% of these patients report a past history of rheumatic fever (option C is also not correct).2,3 In developing countries, the disease may progress much more rapidly, leading to symptoms by the age of 20 (juvenile MS), often within five years of the initial attack of RF (option D is thus not correct).4 All the above statements are false, and therefore, the best option is E.

A 52-year-old woman with a prior history of type 2 diabetes, depression, and SLE presented to her family physician for a routine visit. The patient denied any symptoms such as exertional dyspnea, chest pain, or palpitations. Physical examination revealed a loud first heart sound and a middiastolic rumble. A transthoracic echocardiogram was performed and showed rheumatic valve changes with commissural fusion and diastolic doming of the mitral valve leaflets, a planimetered MVA of 1.8 cm2, and a diastolic pressure half-time of 145 ms. The patient was in normal sinus rhythm and had a valve morphology that was suitable for BMV. According to the ACC/AHA Stages for MS, at which of the following stages would this patient be?

A. Stage A

B. Stage B

C. Stage C1

D. Stage C2

E. Stage D

The answer is B. (Hurst’s The Heart, 14th Edition, Chap. 50) The clinical presentation and the echo findings are consistent with stage B, which includes patients with progressive MS (not severe). Stages A, C, and D typically include patient at risk of MS, asymptomatic patients but with severe disease, and symptomatic subjects with severe ...

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