Page 119 - Clinical Pearls in Cardiology

Valvular Heart Diseases 107

Eventually the right ventricle dilates and fails. The onset
of right ventricular failure is indicated by the appearance
of peripheral edema in a patient with mitral stenosis
(mitral valve area at this point is less than 1 sq cm and is
sometimes referred to as critical stenosis).
11. What are the important complications of mitral
stenosis?
The important complications that can occur in a patient
with mitral stenosis include the following:
• Acute pulmonary edema—attacks of acute pulmonary
edema are usually triggered by new onset of atrial
fibrillation or hyperdynamic circulatory states like
fever, thyrotoxicosis or pregnancy (usually in the late
second trimester).
• Hemoptysis—may be due to pulmonary apoplexy,
winter bronchitis, pulmonary edema or pulmonary
infarction.
• Atrial fibrillation—due to left atrial dilatation.
• Systemic embolism—due to clot formation within
the left atrial appendage. Cerebral emboli are
particularly common, accounting for 60 to 70% of
episodes of systemic embolism.
• Bronchitis—due to chronic passive congestion of the
lungs particularly in winter season (referred to as
“winter bronchitis”).
• Otner’s syndrome—hoarseness of voice due to
paralysis of the left recurrent laryngeal nerve. This is
due to the compression of the nerve between the
enlarged left pulmonary artery and the aorta.
12. What are the clinical features of severe mitral stenosis?
The clinical signs indicating severe mitral stenosis are
the following: