Mitral stenosis natural history, complications and prognosis: Difference between revisions
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==Natural history== | ==Natural history== | ||
The natural history of mitral stenosis secondary to [[rheumatic fever]] (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years. | The natural history of mitral stenosis secondary to [[rheumatic fever]] (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years. | ||
In individuals who were offered mitral valve surgery but refused, ''survival'' with medical therapy alone was 44 ± 6% at 5 years, and 32 ± 8% at 10 years after they were offered correction. | In individuals who were offered mitral valve surgery but refused, ''survival'' with medical therapy alone was 44 ± 6% at 5 years, and 32 ± 8% at 10 years after they were offered correction. | ||
==Complications== | |||
*[[Atrial fibrillation]] and other [[arrhythmia]]s. It is the most common cause of disability from the disease in patients who were previously asymptomatic <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="pmid4552598">{{cite journal| author=Selzer A, Cohn KE| title=Natural history of mitral stenosis: a review. | journal=Circulation | year= 1972 | volume= 45 | issue= 4 | pages= 878-90 | pmid=4552598 | doi= | pmc= | url= }} </ref>. | |||
*[[Pulmonary edema]]. | |||
*[[Hemoptysis]] and pulmonary hemorrhage. | |||
*Thromboembolic events ([[pulmonary embolism]] and [[stroke]], mostly due to atrial fibrillations. | |||
*[[Pulmonary hypertension]] and right atrial and ventricular dilatation. | |||
*[[Tricuspid regurgitation]]. | |||
Around half of the patients may have at least one episode of acute deterioration due on of the complications <ref name="pmid4552598">{{cite journal| author=Selzer A, Cohn KE| title=Natural history of mitral stenosis: a review. | journal=Circulation | year= 1972 | volume= 45 | issue= 4 | pages= 878-90 | pmid=4552598 | doi= | pmc= | url= }} </ref>. | |||
==Prognosis== | |||
Death from mitral stenosis is due to the progressive increase in pulmonary artery pressure which leads to right-sided heart failure and/or pulmonary edema. This happens in around 60 percent of Mitral stenosis cases that are not treated <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="pmid14481743">{{cite journal| author=OLESEN KH| title=The natural history of 271 patients with mitral stenosis under medical treatment. | journal=Br Heart J | year= 1962 | volume= 24 | issue= | pages= 349-57 | pmid=14481743 | doi= | pmc=PMC1017892 | url= }} </ref>. | |||
Other minor causes of death includes <ref name="pmid4780192">{{cite journal| author=Abernathy WS, Willis PW| title=Thromboembolic complications of rheumatic heart disease. | journal=Cardiovasc Clin | year= 1973 | volume= 5 | issue= 2 | pages= 131-75 | pmid=4780192 | doi= | pmc= | url= }} </ref>: | |||
*Systemic thromboembolic events, [[stroke]] and pulmonary embolism. | |||
*[[Infective endocarditis]] (rare). | |||
==References== | ==References== | ||
Revision as of 15:47, 12 September 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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Natural history
The natural history of mitral stenosis secondary to rheumatic fever (the most common cause) is an asymptomatic latent phase following the initial episode of rheumatic fever. This latent period lasts an average of 16.3 ± 5.2 years. Once symptoms of mitral stenosis begin to develop, progression to severe disability takes 9.2 ± 4.3 years.
In individuals who were offered mitral valve surgery but refused, survival with medical therapy alone was 44 ± 6% at 5 years, and 32 ± 8% at 10 years after they were offered correction.
Complications
- Atrial fibrillation and other arrhythmias. It is the most common cause of disability from the disease in patients who were previously asymptomatic [1][2].
- Pulmonary edema.
- Hemoptysis and pulmonary hemorrhage.
- Thromboembolic events (pulmonary embolism and stroke, mostly due to atrial fibrillations.
- Pulmonary hypertension and right atrial and ventricular dilatation.
- Tricuspid regurgitation.
Around half of the patients may have at least one episode of acute deterioration due on of the complications [2].
Prognosis
Death from mitral stenosis is due to the progressive increase in pulmonary artery pressure which leads to right-sided heart failure and/or pulmonary edema. This happens in around 60 percent of Mitral stenosis cases that are not treated [1][3].
Other minor causes of death includes [4]:
- Systemic thromboembolic events, stroke and pulmonary embolism.
- Infective endocarditis (rare).
References
- ↑ 1.0 1.1 ROWE JC, BLAND EF, SPRAGUE HB, WHITE PD (1960). "The course of mitral stenosis without surgery: ten- and twenty-year perspectives". Ann Intern Med. 52: 741–9. PMID 14439687.
- ↑ 2.0 2.1 Selzer A, Cohn KE (1972). "Natural history of mitral stenosis: a review". Circulation. 45 (4): 878–90. PMID 4552598.
- ↑ OLESEN KH (1962). "The natural history of 271 patients with mitral stenosis under medical treatment". Br Heart J. 24: 349–57. PMC 1017892. PMID 14481743.
- ↑ Abernathy WS, Willis PW (1973). "Thromboembolic complications of rheumatic heart disease". Cardiovasc Clin. 5 (2): 131–75. PMID 4780192.