A Rare Presentation of Mitral Stenosis

Abstract

Introduction:Mitral stenosis of rheumatic origin still looms large in developing countries like ours. Symptoms of such conditions occur when the severity starts increasing or atrial fibrillation develops. They are mainly because of pulmonary venous and arterial hypertension, low cardiac output, as well as embolic phenomena. Our case deals with a rare complication of this common disease.Case study: 56 yrs old male of known rheumatic heart disease for many years with moderate symptoms was admitted with complain of respiratory distress of acute onset. He was on regular penicillin prophylaxis, diuretic and rate controlling medicines and had been doing well with those. However few days before admission he had sudden shortness of breath which did not respond as well as it had used to be earlier.On admission, he was orthopnoeic, having tachycardia with irregular pulse and normal blood pressure. ECG showed atrial fibrillation with T wave inversion in V 1-3 and inferior leads. TTEcho revealed dilated LA, mildly enlarged RV with evidence of rheumatic involvement of mitral valve whose area by planimetry was 1.36 cm 2 .Transmitral pressure gradient was about 12 mm Hg (mean). There was no clot in LAA. LV function appeared depressed with hypokinesia noted in infero-posterior area. Considering the age and the presentation of the patient, CAG was performed. It revealed 50-60% stenosis with thrombus in mid RCA with distal cut off and minor plaque in proximal LAD (fig-1). J MEDICINE 2016; 17: 43-45 A Rare Presentation of Mitral Stenosis