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Condition/Disorder Synonyms

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  • Mitral valve stenosis

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ICD-9-CM Codes

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  • 394.0 Mitral stenosis

  • 394.2 Mitral stenosis with insufficiency

  • 396.0 Mitral valve stenosis and aortic valve stenosis

  • 396.1 Mitral valve stenosis and aortic valve insufficiency

  • 746.5 Congenital mitral stenosis

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ICD-10-CM Codes

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  • I05.0 Rheumatic mitral stenosis

  • I05.2 Rheumatic mitral stenosis with insufficiency

  • I34.2 Nonrheumatic mitral (valve) stenosis

  • Q23.2 Congenital mitral stenosis

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Preferred Practice Pattern

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Key Features

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Description

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  • Narrowing of the mitral valve 2

  • Causes reduced blood flow

  • Limited blood flow between left atrium and left ventricle

  • Increased volume and pressure of left ventricle

  • Atrial fibrillation and dysrhythmia-induced thrombi

  • Decreased blood flow can cause decreased cardiac output (CO) leading to lightheadedness, fainting, chest pain

  • Decreased blood flow to the rest of the body and brain

  • Four types2

    • Rheumatic

    • Calcific

    • Congenital

    • Collagen-vascular disease

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Essentials of Diagnosis

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  • Stethoscope auscultation for murmur on carotid artery; bruit sound

  • EKG/ECG 2

  • Echocardiogram

  • Cardiac catheterization

  • Chest x-ray

  • Exercise stress test

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General Considerations

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  • Worsens over time, neither exercise or diet improves the stenosis

  • Education on disease management reduces hospitalization

  • Patients with significant mitral stenosis should not participate in competitive sports

  • Strenuous activity should be limited for symptomatic mitral valve stenosis

  • Signs and symptoms should be monitored

  • Emphasis on wellness and prevention

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Demographics

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  • Affects women twice as often as men

  • Occurs in only 40% of all rheumatic heart disease cases

  • Can be congenital, present from birth

  • Can be caused by age-induced dysfunction of the valve from calcification or atherosclerosis

  • More common in patients with history of rheumatic fever

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Clinical Findings

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Signs and Symptoms

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  • Pulmonary hypertension

  • Pulmonary edema

  • Right ventricular failure

  • Decreased CO

  • Peripheral edema

  • Cough with pink, frothy sputum

  • Dyspnea on exertion

  • Hemoptysis

  • Shortness of breath 2

  • Anginal chest pain that increases with exercise

  • Orthopnea 2

  • Fatigue, weakness 2

  • Fainting, dizziness with activity

  • Palpitations

  • Dysphagia

  • Hoarseness

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Functional Implications

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  • Symptoms depend on degree of stenosis

  • Mild-to-moderate stenosis generally does not cause symptoms

  • Severe mitral stenosis causes progressive shortness of breath and increased risk of left atrial overload

  • Minimial at first and patients may be unaware of reduced cardiovascular capacity until it becomes severe

  • Higher risk of atrial arrhythmias and embolic events

  • Can cause syncope, chest pain, heart failure, deadly cardiac arrhythmias if untreated

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Possible Contributing Causes

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  • Causes of mitral stenosis 2

    • Age-related calcification of mitral valve

    • Congenital valve dysfunction

    • Rheumatic fever

    • Recurrent strep infections

    • Use of medications such as ergot preparation

    • Congenital heart defect

    • Blood clots or tumor can block mitral valve

    • Radiation exposure to chest

    • Systemic ...

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