Mitral stenosis medical therapy
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]
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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.
Pharmacotherapy may include:
- 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.
- Diuretics may be used 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. One of the complications of mitral stenosis is atrial fibrillation, which may lead to systemic embolization.
ACC/AHA Guidelines-Prevention of Systemic Embolization (DO NOT EDIT)
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Class I1 Anticoagulation is indicated in patients with MS and atrial fibrillation (paroxysmal, persistent, or permanent). (Level of Evidence: B) 2 Anticoagulation is indicated in patients with MS and a prior embolic event, even in sinus rhythm. (Level of Evidence: B) 3 Anticoagulation is indicated in patients with MS with left atrial thrombus. (Level of Evidence: B) class iib 1 Anticoagulation may be considered for asymptomatic patients with severe MS and left atrial dimension greater than or equal to 55 mm by echocardiography.* (Level of Evidence: B) 2 Anticoagulation may be considered for patients with severe MS, an enlarged left atrium, and spontaneous contrast on echocardiography. (Level of Evidence: C) |
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References
- ↑ 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.
- ↑ 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.
- ↑ 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.