Rheumatic Heart Disease And The Symptoms Of Mitral Stenosis

Rheumatic heart disease is a long-term complication that arises from untreated or inadequately treated rheumatic fever. One of the most common effects of this condition is mitral stenosis, which occurs when the mitral valve in the heart becomes narrowed, restricting blood flow from the left atrium to the left ventricle.

Recognizing The Physical Signs Of Mitral Stenosis

Patients suffering from severe mitral stenosis often exhibit a distinct facial appearance known as the mitral valve face. This is characterized by a dusky or grayish complexion, purple-red discoloration of the cheeks, and cyanosis (bluish tint) of the lips. These visible symptoms are often among the first clues that lead to a diagnosis.

Cardiovascular And Circulatory Indicators

As the condition progresses, signs of right-sided heart failure may become evident. These include right ventricular enlargement, which can be detected through physical examination or imaging studies. The apical impulse, normally felt at the fifth intercostal space, may instead be palpable in the epigastric region due to displacement from heart enlargement.

Peripheral Signs Of Congestion

Increased pressure in the venous system leads to jugular venous distention, a visible swelling of the neck veins. Additionally, patients may develop hepatomegaly (enlarged liver) and peripheral edema, particularly in the lower extremities. These symptoms reflect the body's struggle to maintain normal circulation in the face of restricted cardiac function.

Heart Sounds And Auscultatory Findings

During auscultation, a mid-to-late diastolic rumbling murmur can be heard at the apex of the heart, best detected when the patient is lying on their left side. This murmur is a hallmark of mitral stenosis. The first heart sound is typically loud and accentuated, and a distinct opening snap of the mitral valve may also be present.

Complications Of Pulmonary Hypertension

When pulmonary hypertension develops as a secondary complication, additional auscultatory changes occur. The second heart sound becomes more prominent in the pulmonary area, and may be accompanied by a wide split. These findings reflect increased pressure in the pulmonary artery and right heart strain.