Mitral stenosis stages: Difference between revisions
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==Stages of Mitral Stenosis== | ==Stages of Mitral Stenosis== | ||
According to the 2014 [[American Heart Association|AHA]]/[[ACC]] [[Guidelines International Network|guidelines]] for management of [[Valvular heart disease|valvular heart diseases]] and [[valve]] [[morphology]], the [[valve]] [[hemodynamics]] characteristics, the consequences of MS on the [[left atrium]] and the [[pulmonary]] [[arterial]] [[system]], and base on the presence or absence of [[Symptom|symptoms]], there are 4 stages of mitral stenosis. | According to the 2014 [[American Heart Association|AHA]]/[[ACC]] [[Guidelines International Network|guidelines]] for management of [[Valvular heart disease|valvular heart diseases]] and [[valve]] [[morphology]], the [[valve]] [[hemodynamics]] characteristics, the consequences of MS on the [[left atrium]] and the [[pulmonary]] [[arterial]] [[system]], and base on the presence or absence of [[Symptom|symptoms]], there are 4 stages of mitral stenosis.<ref name="NishimuraOtto2014">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary|journal=Circulation|volume=129|issue=23|year=2014|pages=2440–2492|issn=0009-7322|doi=10.1161/CIR.0000000000000029}}</ref> | ||
Shown below is a table depicting the 4 stages of mitral stenosis, adapted from 2014 [[AHA/ASA guidelines for the management of spontaneous intracerebral hemorrhage|AHA]]/[[ACC]] [[Medical guideline|guidelines]] for management of [[Valvular heart disease|valvular heart diseases]].<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref> | Shown below is a table depicting the 4 stages of mitral stenosis, adapted from 2014 [[AHA/ASA guidelines for the management of spontaneous intracerebral hemorrhage|AHA]]/[[ACC]] [[Medical guideline|guidelines]] for management of [[Valvular heart disease|valvular heart diseases]].<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref> | ||
<span style="font-size:85%">'''Abbreviations:''' '''MS: ''' mitral stenosis; '''MVA: '''mitral valve area; '''PASP: ''' pulmonary artery systolic pressure</span> | <span style="font-size:85%">'''Abbreviations:''' '''MS: ''' mitral stenosis; '''MVA: '''[[mitral valve]] area; '''PASP: ''' [[pulmonary]] [[artery]] [[Systolic blood pressure|systolic pressure]]</span> | ||
{|Class="wikitable" | {|Class="wikitable" | ||
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|style="background:#DCDCDC;"|'''Stage'''||style="background:#DCDCDC;"|'''Definition'''||style="background:#DCDCDC;"|'''Valve anatomy'''||style="background:#DCDCDC;"|'''Valve hemodynamics'''||style="background:#DCDCDC;"|'''Hemodynamic consequences'''||style="background:#DCDCDC;"|'''Symptoms''' | |style="background:#DCDCDC;"|'''Stage'''||style="background:#DCDCDC;"|'''Definition'''||style="background:#DCDCDC;"|'''Valve anatomy'''||style="background:#DCDCDC;"|'''Valve hemodynamics'''||style="background:#DCDCDC;"|'''Hemodynamic consequences'''||style="background:#DCDCDC;"|'''Symptoms''' | ||
|- | |- | ||
|'''A'''||At risk of | |'''A'''||At risk of MS||❑ Mild [[Diastole|diastolic]] doming of [[mitral valve]] leaflets||❑ Normal transmitral velocity||Absent||Absent | ||
|- | |- | ||
|'''B'''||Progressive | |'''B'''||Progressive MS|| ❑ [[Rheumatic]] [[valve]] changes characterized by commissural fusion and diastolic doming of [[mitral valve]]<br>❑ MVA > 1.5 [[Centimetre|cm<sup>2</sup>]] (planimetered)||❑ Increased transmitral flow velocities<br>❑ [[MVA]] > 1.5 [[Centimetre|cm<sup>2</sup>]] <br>❑ [[Pressure]] half time during [[diastole]] < 150 ms||❑ Mild to moderate [[left atrial]] enlargement<br>❑ Normal [[pulmonary]] [[pressure]] at rest ||Absent | ||
|- | |- | ||
|'''C'''|| | |'''C'''||[[Asymptomatic]] severe MS||❑ [[Rheumatology|Rheumatic]] [[valve]] changes characterized by commissural fusion and [[Diastole|diastolic]] doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]]<br>❑ MVA ≤ 1 [[Centimetre|cm<sup>2</sup>]] in very severe [[MS]]|| ❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]] (planimetered)<br>❑ MVA ≤ 1 [[Centimetre|cm<sup>2</sup>]] (planimetered) in very severe [[MS]]<br>❑ [[Diastole|Diastolic]] [[pressure]] half time ≥ 150 ms<br> ❑ [[Diastole|Diastolic]] pressure half time ≥ 220 ms with very severe [[MS]]||❑ Severe [[left atrial]] enlargement<br>❑ PASP > 30 [[MmHg|mm Hg]]||Absent | ||
|- | |- | ||
|'''D'''|| | |'''D'''||[[Symptomatic]] severe MS||❑ [[Rheumatology|Rheumatic]] [[valve]] changes characterized by [[Commissural fibers|commissural]] fusion and [[Diastole|diastolic]] doming of [[mitral valve]]<br> ❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]] (planimetered)||❑ MVA ≤ 1.5 [[Centimetre|cm<sup>2</sup>]]<br>❑ MVA ≤ 1 [[Centimetre|cm<sup>2</sup>]] in very severe [[MS]]<br>❑ Diastolic pressure half time ≥ 150 ms<br> ❑ [[Diastole|Diastolic]] [[pressure]] half time ≥ 220 ms with very severe [[MS]]||❑ Severe left atrial enlargement<br>❑ PASP > 30 [[MmHg|mm Hg]]||❑ [[Dyspnea]] on exertion<br>❑ Decreased [[exercise]] [[tolerance]] | ||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 20:16, 13 March 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
According to the 2014 AHA/ACC guidelines for management of valvular heart diseases and valve morphology, the valve hemodynamics characteristics, the consequences of MS on the left atrium and the pulmonary arterial system, and base on the presence or absence of symptoms, there are 4 stages of mitral stenosis. Staging of mitral stenosis (MS) is of utmost importance because it dictates the appropriate management plan for the affected patients.
Stages of Mitral Stenosis
According to the 2014 AHA/ACC guidelines for management of valvular heart diseases and valve morphology, the valve hemodynamics characteristics, the consequences of MS on the left atrium and the pulmonary arterial system, and base on the presence or absence of symptoms, there are 4 stages of mitral stenosis.[1]
Shown below is a table depicting the 4 stages of mitral stenosis, adapted from 2014 AHA/ACC guidelines for management of valvular heart diseases.[2]
Abbreviations: MS: mitral stenosis; MVA: mitral valve area; PASP: pulmonary artery systolic pressure
Stage | Definition | Valve anatomy | Valve hemodynamics | Hemodynamic consequences | Symptoms |
A | At risk of MS | ❑ Mild diastolic doming of mitral valve leaflets | ❑ Normal transmitral velocity | Absent | Absent |
B | Progressive MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA > 1.5 cm2 (planimetered) |
❑ Increased transmitral flow velocities ❑ MVA > 1.5 cm2 ❑ Pressure half time during diastole < 150 ms |
❑ Mild to moderate left atrial enlargement ❑ Normal pulmonary pressure at rest |
Absent |
C | Asymptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA ≤ 1.5 cm2 ❑ MVA ≤ 1 cm2 in very severe MS |
❑ MVA ≤ 1.5 cm2 (planimetered) ❑ MVA ≤ 1 cm2 (planimetered) in very severe MS ❑ Diastolic pressure half time ≥ 150 ms ❑ Diastolic pressure half time ≥ 220 ms with very severe MS |
❑ Severe left atrial enlargement ❑ PASP > 30 mm Hg |
Absent |
D | Symptomatic severe MS | ❑ Rheumatic valve changes characterized by commissural fusion and diastolic doming of mitral valve ❑ MVA ≤ 1.5 cm2 (planimetered) |
❑ MVA ≤ 1.5 cm2 ❑ MVA ≤ 1 cm2 in very severe MS ❑ Diastolic pressure half time ≥ 150 ms ❑ Diastolic pressure half time ≥ 220 ms with very severe MS |
❑ Severe left atrial enlargement ❑ PASP > 30 mm Hg |
❑ Dyspnea on exertion ❑ Decreased exercise tolerance |
References
- ↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Circulation. 129 (23): 2440–2492. doi:10.1161/CIR.0000000000000029. ISSN 0009-7322.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.