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14: MITRAL STENOSIS

Natalie V. Wessel, DO, MPH; Eric Shamus, PhD, DPT, PT, CSCS

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CONDITION/DISORDER SYNONYM

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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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  • 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure1

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PATIENT PRESENTATION

A 55-year-old male, originally from Guatemala, is preparing to run his first 5K. He states that while training his heart was racing and he coughed up a little bit of blood. He states that he had rheumatic fever as a child, but has been very healthy ever since. Vitals are: Pulse: 80, Respirations: 16, Blood Pressure: 126/80, and SpO2% of 99%. On physical examination there is an opening snap and a faint diastolic murmur over the cardiac apex. A chest X-ray and EKG are within normal limits and the cardiac echo reveals a narrowing of the mitral valve.

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KEY FEATURES

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Description
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  • Narrowing of the mitral valve2

  • 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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FIGURE 14-1

Radiographic appearance of left heart failure. A. Acute. Patient with acute mitral regurgitation because of the rupture of chordae tendineae showing the “bat-wings” appearance of a severe alveolar type of pulmonary edema and a normal-sized heart. B. Chronic. Patient with severe mitral and tricuspid regurgitation and mild aortic regurgitation. This is a predominantly left-sided failure pattern. Note the gross cardiomegaly with striking cephalization and interstitial pulmonary edema. The giant left atrium forms the right cardiac border (open arrow), makes its appendage bulge outward on the left side (upper large arrow), and splays the mainstem bronchi wide apart (solid lines). The huge right atrium forms a double density within the right cardiac border (three small arrows). The small upper arrow marks the peribronchial cuffing of edema fluid. The large lower arrow points to multiple Kerley B lines. C. Magnified view of right costophrenic sulcus showing multiple Kerley B lines (arrow). D. A 44-year-old woman with severe mitral stenosis (MS). The radiograph shows a diffuse stippling with fine nodules representing hemosiderosis. Hemosiderin-laden macrophages were found in her sputa. E. Posteroanterior radiograph of a 63-year-old man with severe MS, status post–mitral-valve replacement, shows multiple scattered bony nodules (arrows) 2 to 10 mm in ...

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