Mitral stenosis medical therapy
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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]
Overview
Patients with mitral stenosis who develop atrial fibrillation require anticoagulation and rate control.
Asymptomatic Patients
In asymptomatic patients, use endocarditis prophylaxis and chronic anticoagulation for intermittent or chronic atrial fibrillation, systemic embolism and marked LA enlargement (>55mm).
Symptomatic Patients
Anticoagulation
- 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].
Digoxin
- Digitalis may be used to strengthen the heartbeat and to slow the ventricular response in patients with atrial arrhythmias. Slowing the heart rate prolongs the diastolic filling time and allows better filling of the left ventricle.
Diuretics
- Diuretics may be used to remove excess fluid in the lungs in patients with pulmonary edema.
Low Sodium Diet
A low-sodium diet may be helpful.
Activity Restriction
Once a a patient develops symptoms, activity may be restricted.
ACC/AHA Guidelines- Prevention of Systemic Embolization (DO NOT EDIT) [3]
| Class I |
| "1.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) " |
Sources
- 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease [3].
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.
- ↑ 3.0 3.1 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". J Am Coll Cardiol. 52 (13): e1–142. doi:10.1016/j.jacc.2008.05.007. PMID 18848134.