One of the most common clinical applications of simultaneous exercise and hemodynamic measurements is in the patient with mitral stenosis and borderline resting measurements. Exercising such a patient to the level of a symptomatic state with simultaneous Doppler measurement of mitral valve gradient and pulmonary artery pressure (or similar measurements made in the catheterization laboratory) may better elucidate the physiologic severity of the mitral valvular disease.
What are the other causes of mitral stenosis besides rheumatic heart disease?
Congenital mitral stenosis is the second most common cause of mitral stenosis and is far less frequent than rheumatic fever. Rarely, mitral stenosis can be a complication of malignant carcinoid, systemic lupus erythematosus, rheumatoid arthritis, and the mucopolysaccharidoses of the Hunter-Hurler phenotype. Two obscure causes of mitral stenosis are eosinophilic fibroelastosis and the drug methysergide (a vasodilator used for headaches), which is now rarely, if ever, used. Degenerative mitral annular calcification also can cause stenosis.
What myocardial tumor can mimic mitral stenosis?
Atrial myxoma, specifically left atrial myxoma, can present with similar findings on physical examination, including a diastolic rumble and a loud Sj. An opening snap is characteristically absent. The presence of systemic symptoms, such as fever, arthralgia, malaise, cachexia, rash, and Raynaud’s phenomenon, can be clues to the presence of myxoma.
20. What is the NAME syndrome?
This syndrome is the association of:
N = Nevi
A = Atrial myxoma M = Myxoid neurofibromas E = Ephelides (freckles)
The syndrome is inherited with an autosomal dominant pattern. Seven percent of all atrial myxomata are inherited.
What is Ortner’s syndrome?
Hoarseness caused by a dilated left atrium compressing the left recurrent laryngeal nerve.
What is the role of an exercise evaluation in a patient with mitral stenosis? Photo Gallery
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