Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA class [I-IV]), orthopnea, and paroxysmal nocturnal dyspnea. History significant for rheumatic fever in childhood. Reports palpitations suggestive of atrial fibrillation, occasional hemoptysis, and systemic thromboembolic symptoms. No chest pain or syncope reported.
Clinical Examination Findings
Cardiovascular exam reveals a tapping apex beat, palpable S1, and a diastolic thrill at the apex. Auscultation demonstrates a loud S1, an opening snap (OS) following S2, and a low-pitched rumbling mid-diastolic murmur at the apex, best heard in the left lateral decubitus position. Signs of right heart failure noted: elevated JVP, peripheral edema, and hepatomegaly. Lungs clear to auscultation or with bibasilar crackles.
Treatment Protocol
Initiate medical management with diuretics for volume overload, beta-blockers or rate-control agents for atrial fibrillation, and anticoagulation (Warfarin/NOACs) if AF is present. Prophylaxis against recurrent rheumatic fever with secondary penicillin prophylaxis as per guidelines. Evaluate for percutaneous mitral commissurotomy (PMC) or surgical mitral valve replacement/repair based on valve morphology and severity.