Mitral stenosis medical therapy: Difference between revisions

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(New page: {{SI}} {{CMG}} '''Associate Editor-In-Chief:''' {{CZ}} {{Editor Help}} ==Overview== The choice of treatment depends on the symptoms present and the condition and function of the heart. ...)
 
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{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]][mailto:msbeih@perfuse.org]; {{CZ}}
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'''Associate Editor-In-Chief:''' {{CZ}}
==Medical treatment==
 
{{Editor Help}}
 
==Overview==
The choice of treatment depends on the symptoms present and the condition and function of the heart. Patients with high blood pressure or a weakened heart muscle may be given medications to reduce the strain on the heart and help improve the condition.
The choice of treatment depends on the symptoms present and the condition and function of the heart. Patients with high blood pressure or a weakened heart muscle may be given medications to reduce the strain on the heart and help improve the condition.


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The 2006 American College of Cardiology/American Heart Association ([[ACC]]/[[AHA]]) guidelines for management of valvular heart disease recommended routine repeat echocardiography every year for patients with severe mitral stenosis, every one to two years for patients with moderate mitral stenosis and every three to five years for patients with mild mitral stenosis  <ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172  }} </ref>. By echocardiography, the doctor can assess the pulmonary artery pressure to decide if the surgery is indicated for the patient with mitral stenosis or not.
The 2006 American College of Cardiology/American Heart Association ([[ACC]]/[[AHA]]) guidelines for management of valvular heart disease recommended routine repeat echocardiography every year for patients with severe mitral stenosis, every one to two years for patients with moderate mitral stenosis and every three to five years for patients with mild mitral stenosis  <ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172  }} </ref>. By echocardiography, the doctor can assess the pulmonary artery pressure to decide if the surgery is indicated for the patient with mitral stenosis or not.


Hospitalization may be required for diagnosis and treatment of severe symptoms. Surgical repair or replacement of the valve is recommended if heart function is poor, symptoms are severe, or the condition gets worse.
In asymptomatic patients, use endocarditis prophylaxis and chronic anticoagulation for intermittent or chronic atrial fibrillation, systemic embolism and marked LA enlargement (>55mm).
Medical therapy can relieve symptoms, but the patient may need surgery to relieve the blood flow obstruction by mitral stenosis. Some studies showed that surgical treatment reduces the overall mortality rate of mitral stenosis compared to medical treatment <ref name="pmid14439687">{{cite journal| author=ROWE JC, BLAND EF, SPRAGUE HB, WHITE PD| title=The course of mitral stenosis without surgery: ten- and twenty-year perspectives. | journal=Ann Intern Med | year= 1960 | volume= 52 | issue=  | pages= 741-9 | pmid=14439687 | doi= | pmc= | url= }} </ref><ref name="pmid6015840">{{cite journal| author=Dahl JC, Winchell P, Borden CW| title=Mitral stenosis. A long term postoperative follow-up. | journal=Arch Intern Med | year= 1967 | volume= 119 | issue= 1 | pages= 92-7 | pmid=6015840 | doi= | pmc= | url= }} </ref><ref name="pmid4889600">{{cite journal| author=Roy SB, Gopinath N| title=Mitral stenosis. | journal=Circulation | year= 1968 | volume= 38 | issue= 1 Suppl | pages= 68-76 | pmid=4889600 | doi= | pmc= | url= }} </ref>.


==Pharmacotherapy==
The decision of whether to proceed with vavluloplasty or surgical commissurotomy depends on the severity of symptoms and/or severe (>50mm Hg) PHTN.
* In asymptomatic patients, use endocarditis prophylaxis and chronic anticoagulation for intermittent or chronic atrial fibrillation, systemic embolism and marked LA enlargement (>55mm).
* In symptomatic patients, control heartrate and Maintain NSR (normal sinus rhythm) (digoxin, antiarrhythmic agents) and B-blockers.  Use diuretics for control of pulmonary edema.  The decision of whether to proceed with vavluloplasty or surgical commissurotomy depends on the severity of symptoms and/or severe (>50mm Hg) PHTN.  Relative indications would be for Class II, III symptoms, episodic pulmonary edema, prevention of thromboembolism, or moderate (45-50mm Hg) PHTN.  The decision of whether valvuloplasty is superior to surgery depends on age (<60 favors valvuloplasty), and Cath/ECHO findings (e.g. LVEDP, degree of mobility, thickening and calcification).  The average end result with both strategies is about 2 cm2.  Moderate or greater MR (mitral regurgitation) and LA thrombus are contraindications to valvuloplasty.


==References==
==References==

Revision as of 15:47, 8 September 2011

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D.[2]; Cafer Zorkun, M.D., Ph.D. [3]

Medical treatment

The choice of treatment depends on the symptoms present and the condition and function of the heart. Patients with high blood pressure or a weakened heart muscle may be given medications to reduce the strain on the heart and help improve the condition.

Anticoagulant or antiplatelet medications (blood thinners) may be used to prevent clots from forming in patients with atrial fibrillation. The 2006 ACC/AHA guidelines on the management of valvular heart disease recommended long-term oral anticoagulation in patients with mitral stenosis who have a prior embolic event, left atrial thrombus, or atrial fibrillation [1][2].

Digitalis may be used to strengthen the heartbeat, along with diuretics (water pills) to remove excess fluid in the lungs.

A low-sodium diet may be helpful. Most people have no symptoms; but if a person develops symptoms, activity may be restricted.

Cases of mild mitral stenosis (mitral valve area >1.5 cm2) can be followed up yearly with history, physical examination, EKG and some imaging studies like echocardiography.

The 2006 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for management of valvular heart disease recommended routine repeat echocardiography every year for patients with severe mitral stenosis, every one to two years for patients with moderate mitral stenosis and every three to five years for patients with mild mitral stenosis [3]. By echocardiography, the doctor can assess the pulmonary artery pressure to decide if the surgery is indicated for the patient with mitral stenosis or not.

In asymptomatic patients, use endocarditis prophylaxis and chronic anticoagulation for intermittent or chronic atrial fibrillation, systemic embolism and marked LA enlargement (>55mm).

The decision of whether to proceed with vavluloplasty or surgical commissurotomy depends on the severity of symptoms and/or severe (>50mm Hg) PHTN.

References

  1. ↑ Salem DN, O'Gara PT, Madias C, Pauker SG, American College of Chest Physicians (2008). "Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 593S–629S. doi:10.1378/chest.08-0724. PMID 18574274.
  2. ↑ Singer DE, Albers GW, Dalen JE, Fang MC, Go AS, Halperin JL; et al. (2008). "Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 546S–592S. doi:10.1378/chest.08-0678. PMID 18574273.
  3. ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172.

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