Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA class [I-IV]), orthopnea, and paroxysmal nocturnal dyspnea. Reports symptoms of reduced cardiac output including fatigue and exercise intolerance. History significant for [rheumatic fever/prior valve surgery]. Denies chest pain or syncope. Palpitations noted, suggestive of paroxysmal atrial fibrillation.
Clinical Examination Findings
Cardiovascular exam: Irregularly irregular rhythm (if AFib). Precordial palpation reveals diastolic thrill at the apex. Auscultation: Loud S1, opening snap followed by a low-pitched diastolic rumbling murmur at the apex, best heard in the left lateral decubitus position. Signs of right heart failure: JVD, hepatomegaly, and peripheral edema. Pulmonary exam: Basilar crackles consistent with pulmonary venous hypertension.
Treatment Protocol
Management plan: 1. Rate control for atrial fibrillation (Beta-blockers/CCBs). 2. Diuretic therapy (Furosemide) for symptomatic pulmonary congestion. 3. Anticoagulation (Warfarin/DOACs) if AFib is present. 4. Referral for echocardiographic assessment of valve area (<1.0 cm²). 5. Evaluation for percutaneous mitral commissurotomy (PMC) or surgical mitral valve replacement.