Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA class [I-IV]), orthopnea, and paroxysmal nocturnal dyspnea. Reports associated symptoms of palpitations, fatigue, and occasional hemoptysis. No history of syncope or chest pain. Symptoms exacerbated by physical activity and emotional stress.
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 following S2, and a low-pitched diastolic rumbling murmur at the apex, best heard in the left lateral decubitus position. Signs of right-sided heart failure noted: elevated JVP, peripheral edema, and hepatomegaly.
Treatment Protocol
Management plan includes: 1. Rate control for atrial fibrillation (if present) using beta-blockers or calcium channel blockers. 2. Diuretic therapy for volume overload management. 3. Anticoagulation indicated if atrial fibrillation or left atrial thrombus is present. 4. Evaluation for percutaneous mitral commissurotomy (PMC) or surgical mitral valve replacement/repair based on valve anatomy and severity.