Treatment of Rheumatic Heart Disease with Severe Isolated Mitral Stenosis
Rheumatic heart disease presenting with severe isolated mitral stenosis is a well-defined clinical scenario with specific evidence-based management priorities. Symptomatic patients require a structured approach targeting the haemodynamic consequences of this valve lesion.
Clinical Scenario
This protocol is directed at patients with severe isolated mitral stenosis as the dominant valve pathology in the setting of rheumatic heart disease. The clinical presentation in symptomatic patients informs both the selection and timing of treatment.
Treatment Approach (partial overview)
Management in this setting involves agents to reduce preload along with therapy to control heart rate — the complete regimen, sequencing, and clinical targets are detailed in the full protocol.
Full agent selection, dosing approach, and treatment algorithm available via the protocol below.
References
DOI: 10.1161/CIR.0000000000000921
- In symptomatic patients with severe isolated rheumatic MS, the low cost and rapid turnaround time associated with BMV compared with open heart surgery make it an attractive option.
- Diuretic agents are indicated to reduce preload.
- Loop diuretic agents are useful in acute pulmonary edema and for long-term management; however, overdiuresis can reduce preload and compromise cardiac output.
- Other diuretic agents such as aldosterone blockers (spironolactone and eplerenone) and thiazide diuretic drugs (metolazone and chlorthalidone) are also used.
- β-Blockers reduce the heart rate through their negative chronotropic effect, allowing for greater diastolic filling into the left ventricle, and this can help reduce left atrial pressure and provide symptom relief.
View source ↗