HAS- BLED SCORE

HAS-BLED is a scoring system developed to assess 1-year risk of major bleeding in people taking anticoagulants for atrial fibrillation.

 

A 45 year old female presents with 5 months progressive history of increasing shortness of breath, dizziness, tiredness and occasional chest pains

 A 45 year old female presents with 5 months progressive history of increasing shortness of breath, dizziness, tiredness and occasional chest pains. She gets fainting spells on occasions as well. At night times, she gets up from sleep panting for breath on occasions. She also complains of palpitations on occasions.

Onexamination ,

Her cheeks are flushed.

On auscultation , there is a loud first heart sound, a high pitched early diastolic sound and a mid diastolic low pitched rumbling murmur.

An Echocardiogram is shown below:

1. What are findings on the Echocardiogram?

2. What is the most likely Diagnosis ?

3. What are the complications of this condition?

4. How will you manage this patient?

5. What is the most common cause of this condition ?

6. How can severity of this condition be graded ?

7 . What is the survivall rate of this disease ?

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Answers given in comments section.

1. What are findings on the Echocardiogram?

 Thickening of the mitral valve cusps; 

Enlargement of the Left Atrium ,and 

A reduction in the size of the mitral valve orifice .

2. What is the most likely Diagnosis ? 

Mitral stenosis. Mitral valve stenosis, also known as mitral stenosis, occurs when the mitral valve opening is narrowed. This means that not enough blood can flow through it. 

Mitral valve stenosis can lead to a variety of issues, including fatigue, difficulty breathing, blood clots, and heart failure.

3. What are the complications of this condition? 

Untreated, mitral valve stenosis can lead to complications such as:

High blood pressure in the lung arteries (pulmonary hypertension).

Heart failure.

Fluid in the lungs (pulmonary edema).

Heart enlargement.

Atrial fibrillation.

Blood clots. Mitral stenosis impairs left ventricular filling so that there is a decrease in end-diastolic volume (preload).This leads to a decrease in stroke volume by the Frank-Starling mechanism and a fall in cardiac output.

4 . How is mitral valve stenosis treated?

Anticoagulants, or blood thinners, to reduce the risk of blood clots.

Diuretics to reduce fluid buildup through increased urine output.

Antiarrhythmics to treat abnormal heart rhythms.

Beta-blockers to slow heart rate. Surgical approaches to the management of mitral stenosis include closed commissurotomy, open commissurotomy, and mitral valve replacement

5 .What is the most common cause of this condition ?

The most common cause of mitral valve stenosis is rheumatic fever ,a complication of strep throat.

6 . What is considered severe mitral stenosis?

Most patients with moderate to severe mitral stenosis will have some degree of left atrial enlargement (LAE) due to the chronic increases in left atrial pressures, predisposing them to atrial fibrillation.

...

Pressure Gradient (mmHg) Mitral Valve Area (cm2)

Mild 1-5 2.5-4.0

Moderate 6-10 1.0-2.5

Severe > 10 < 1.0

7. What is the survival rate of this disease? 

The crude cumulative 10-year survival was 73.7% among patients with normal left atrial size, 62.5% among those with mild left atrial enlargement, 54.8% among those with moderate left atrial enlargement and 45% among those with severe left atrial enlargement (p < 0.001).