Mitral stenosis medical therapy

Revision as of 21:19, 1 February 2013 by Charmaine Patel (talk | contribs)
Jump to navigation Jump to search

Mitral Stenosis Microchapters

Home

Patient Information

Overview

Pathophysiology

Causes

Differentiating Mitral Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Stages

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

Echocardiography

Cardiac MRI

Cardiac Catheterization

Treatment

Overview

Medical Therapy

Percutaneous Mitral Balloon Commissurotomy (PMBC)

Surgery

Follow Up

Prevention

Case Studies

Case #1

Mitral stenosis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Mitral stenosis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onMitral stenosis medical therapy

CDC on Mitral stenosis medical therapy

Mitral stenosis medical therapy in the news

Blogs on Mitral stenosis medical therapy

Directions to Hospitals Treating Mitral Stenosis

Risk calculators and risk factors for Mitral stenosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D.[2]; Cafer Zorkun, M.D., Ph.D. [3]

Overview

Patients with mitral stenosis who develop atrial fibrillation require anticoagulation and rate control.

Medical Therapy

Asymptomatic Patients

In asymptomatic patients, use endocarditis prophylaxis and chronic anticoagulation for intermittent or chronic atrial fibrillation, systemic embolism and marked LA enlargement (>55mm).

Symptomatic Patients

Anticoagulation

Digoxin

  • Digitalis may be used to strengthen the heartbeat and to slow the ventricular response in patients with atrial arrhythmias. Slowing the heart rate prolongs the diastolic filling time and allows better filling of the left ventricle.

Diuretics

Low Sodium Diet

A low-sodium diet may be helpful.

Activity Restriction

Once a a patient develops symptoms, activity may be restricted.

2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT)[3]

Systemic Embolization Prevention (DO NOT EDIT)[3]

Class I
"1. Anticoagulation is indicated in patients with mitral stenosis and atrial fibrillation (paroxysmal, persistent, or permanent). (Level of Evidence: B) "
"2. Anticoagulation is indicated in patients with mitral stenosis and a prior embolic event, even in sinus rhythm. (Level of Evidence: B) "
"3. Anticoagulation is indicated in patients with mitral stenosis with left atrial thrombus. (Level of Evidence: B) "
Class IIb
"1. Anticoagulation may be considered for asymptomatic patients with severe mitral stenosis and left atrial dimension greater than or equal to 55 mm by echocardiography.* (Level of Evidence: B) "
"2. Anticoagulation may be considered for patients with severe mitral stenosis, an enlarged left atrium, and spontaneous contrast on echocardiography. (Level of Evidence: C) "
* This recommendation is based on a grade C level of evidence given by the American College of Chest Physicians Fourth Consensus Conference on Antithrombotic Therapy. [4]

References

  1. Salem DN, O'Gara PT, Madias C, Pauker SG, American College of Chest Physicians (2008). "Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 593S–629S. doi:10.1378/chest.08-0724. PMID 18574274.
  2. Singer DE, Albers GW, Dalen JE, Fang MC, Go AS, Halperin JL; et al. (2008). "Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 546S–592S. doi:10.1378/chest.08-0678. PMID 18574273.
  3. 3.0 3.1 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)
  4. Levine HJ, Pauker SG, Eckman MH (1995). "Antithrombotic therapy in valvular heart disease". Chest. 108 (4 Suppl): 360S–370S. PMID 7555189. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources