Mitral Stenosis Case presentation

Mitral Stenosis Case presentation

1. Dr.Chinmoy Saha M.D. (Cardiology) Phase B Resident Case Presentation

2. Name- Rubel Age-40 yrs Sex-Male Occupation-Electrician Marital Status-Married Religion-Islam Address- Mughda,Dhaka Date of admission-29/4/2017 Date of Examination-3/5/2017 Particulars of the patient

3. Shortness of breath for 2 months. Easy fatigability for the same duration. Chief Complaints

4. According to the statement of the patient,he was reasonably well 2 months back.Then he developed shortness of breath,more on exertion,which is gradually increasing in nature.Initially,the patient felt breathlessness on moderate to severe exertion,but for the last few weeks it has become so severe that he felt breathlessness even on mild exertion.But he has no history of breathlessness on lying flat with no diurnal variation. H/O Present illness

5. He also complains easy fatigability after exertion for the same duration which is progressively worsening. Cont …

6. On query,he mentioned about occasional cough for last 4 months which was productive,with no seasonal variation and not exacerbated after posture change.He noticed streak of blood mixed with sputum on three or four occasions.For this reason,he consulted with a physician and he was extensively investigated for tuberculosis.But investigations were negative.For further evaluation he was referred to a cardiologist and he was diagnosed as a case of valvular heart disease.With these complaints he got admitted in DMCH on 28/4/17 for further management. Cont …

7. Throughout the course of his illness,he had no history of weightloss,fever,palpitation,chest pain, leg swelling,hoarseness of voice or difficulty in swallowing. Cont …

8. No history of childhood fever with joint pain. H/O Past illness

9. He comes from a low socio economic family. He lives in paka house and use sanitary latrine. Socio-Economic history

10. He has three sisters. Parents are alive. No such illness runs in his family. Family History

11. He could not mention properly. Immunization History

12. Tab.Phenoxymethyl penicillin 250mg 1+0+1 Tab.metoprolol 25 mg ½+0+ ½ Drug history

13. Appearance: ill looking Body built: average Co-operation: cooperative Decubitus: On choice Anaemia : absent Jaundice: absent Cyanosis: absent Koilonychia : absent Leukonychia : absent General Examination

14. Clubbing: absent Dehydration: absent Edema: absent Pulse:72 beats/ min,regular,low volume BP: 100/70 mm of Hg Respiratory rate:14/min Temp : 99 F JVP: Not raised Lymphnode : no lymphadenopathy Thyroid gland: no thyromegaly Contd …

15. Inspection : A visible impulse on the left 5 th intercostal space No scar mark or bony deformity Palpation : Apex beat is felt in left 5 th intercostal area just medial to the midclavicular line,tapping in nature R ight parasternal heave is present P alapable P2 is present Cardiovascular system

16. 1 st heard sound is loud in mitral area normal in other area Pulmonary component of 2 nd heart sound is also loud in pulmonary area There is low pitched,localised,rough,rumbling murmur best heard on mitral area,in left lateral position with the bell of the stethoscope,breath hold after expiration with presystolic accentuation. Opening snap is also present. Base of Lungs: Clear Auscultation

17. Reveals no abnormality Other systemic examination

18. Mitral stenosis with pulmonary HTN Provisional DX

19. Tricuspid stenosis Differential Dx

20. CBC: Hb:14 gm /dl TWBC :8000/mm3 N:62 % Esr:20 mm S.Creatinine:1.3 mg/dl S.Electrolyte : Na :143 mmol /l K: 4.63 mmol /l Investigation

21. ECG

22. CXR

23. ECHOCARDIOGRAM

24. Chronic rheumatic heart disease with moderate mitral stenosis with pulmonary hypertension Final Diagnosis

25. Medical Therapy Intervention -PMV Surgery 1.CMC 2.OMC 3.Mitral Valve replacement Treatment Plan

26. 1.Patient without symptoms,who has mild MS need no specific treatment ,only prevention of rheumatic fever. 2.Only mild symptoms of exertional dyspnea can be treated with diuretics. 3.For atrial fibrillation,rate control measure or cardioversion . 4.Anticoagulant may be used. Medical Therapy

27. Indication For Mitral Balloon Valvotomy

28. Wilkin Score

29. 1.Score Higher than 11: should not undergo valvuloplasty 2.Score of 9-11: gray zone,suboptimal result 3.Score less than 8 : optimal result Interpretation of Wilkin Score

30. TAB.Phenoxymethyl Penicillin 250mg 1+0+1 Tab.Frusemide+spirolactone 20/50 1+0+0 Tab.Levofloxacin 500mg 0+0+1 Tab.Rabeprazole 20mg 1+0+1 ONGOING RX

31. Next Plan

32. Thank You