تضيق الصمام التاجي

Definition

Mitral stenosis is narrowing of the valve between the left atrium and left ventricle, so pressure builds up behind it in the atrium and then the lungs.

Cause

Usually rheumatic fever years earlier, still common in some regions.

Symptoms

• Breathlessness on effort, then lying flat
• Fatigue and sometimes haemoptysis
• Palpitations from atrial fibrillation due to left atrial enlargement
• Symptoms worsen in pregnancy and with tachycardia, which shortens ventricular filling time

Signs

A low-pitched diastolic murmur at the apex and a loud first heart sound.

Diagnosis

Echocardiography.

Treatment

• Diuretics for congestion and beta-blockers for rate control
• Anticoagulation with AF, usually warfarin in moderate-to-severe stenosis
• Balloon valvotomy or valve replacement

Nursing care

• Watch for pulmonary congestion and stroke
• Teach rheumatic fever prophylaxis as planned and dental care

Exam point

Tachycardia worsens mitral stenosis, so rate control is a core part of treatment.