mitral stenosis; rheumatic heart disease; mitral regurgitation;

1. MBBS, FCPS, MD, FACC, FESC, FRCP, FSCAI,
FCCP,FAPSC, FAPSIC, FAHA,FACP,FASE
Professor and Head of Cardiology
Colonel Malek Medical College , Manikganj
.
drtoufiq19711@yahoo.com13/8/2019

2. Case report 1
• A 17 years old lady presented with shortness of
breath on exertion, increasing in intensity for last 2
months. On examination she is dysnoeic, pulse-
105/min, regular, BP-Normal, RR-28/min, diastolic
thrill in apex, S1 loud P2-loud, mid-diastolic murmur
in apical area best heard in left lateral position, breath
held in expiration. ECG-sinus tachycardia, CXR-P/A
view-straightening of left border, double right border,
Echocardiogram-Moderate mitral stenosis with mild
pulmonary hypertension. Patient being treated with
medical treatment and she is doing well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
2
Mitral Stenosis

3. Case report 2
• A 23 years old lady presented with shortness of
breath on exertion, increasing in intensity for last 3
months. On examination she is dysnoeic, pulse-
110/min, regular, BP-Normal, RR-30/min, diastolic
thrill in apex, S1 loud P2-loud, mid-diastolic murmur
in apical area best heard in left lateral position, breath
held in expiration. ECG-sinus tachycardia, CXR-P/A
view-straightening of left border, double right border,
Echocardiogram-severe mitral stenosis with
moderate pulmonary hypertension with Wilkins echo
score-6. Patient underwent PTMC and she is doing
well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
3
Mitral Stenosis

4. Case report 3
• A 39 years old lady presented with shortness of breath
on exertion for last 10 years, increasing in intensity for
last 3 months. She was treated with anti-asthmatic
drugs. On examination she is dysnoeic, pulse-130/min,
irregular, BP-110/80 mm Hg, RR-31/min, diastolic thrill
in apex, S1 soft P2-loud, mid-diastolic murmur in
apical area best heard in left lateral position, breath
held in expiration. ECG- Atrial Fibrillation, CXR-P/A
view-Cardiomegaly, straightening of left border,
double right border, Echocardiogram-severe mitral
stenosis with mild MR with moderate pulmonary
hypertension with Wilkins echo score-8. Patient
underwent PTMC and she is doing well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
4
Mitral Stenosis

5. Case report 4
• A 43 years old lady presented with shortness of breath
on exertion for last 10 months, increasing in intensity
for last 1 months. She had h/o CMC 15 years back . On
examination she is dysnoeic, pulse-110/min, irregular,
BP-100/75 mm Hg, RR-28/min, diastolic thrill in apex,
S1 soft P2-loud, mid-diastolic murmur in apical area
best heard in left lateral position, breath held in
expiration. ECG- Atrial Fibrillation, CXR-P/A view-
Cardiomegaly, straightening of left border, double right
border, Echocardiogram-severe mitral stenosis with
severe MR with severe pulmonary hypertension with
Wilkins echo score-12. Patient underwent MVR and
she is doing well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
5
Mitral Stenosis

6. Case report 5
• A 53 years old lady presented with shortness of breath
on exertion for last 8 months, increasing in intensity for
last 1.5 months. She had h/o CMC 20 years back, H/O
PTMC 10 years back . On examination she is dysnoeic,
pulse-118/min, irregular, BP-90/70 mm Hg, RR-32/min,
diastolic thrill in apex, S1 soft P2-loud, mid-diastolic
murmur in apical area best heard in left lateral position,
breath held in expiration and pansystolic murmur in
apical area with radiation to left axilla. ECG- Atrial
Fibrillation, CXR-P/A view-Cardiomegaly, straightening
of left border, double right border, Echocardiogram-
severe mitral stenosis with severe MR with severe
pulmonary hypertension with Wilkins echo score-13.
Patient underwent MVR and she is doing well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
6
Mitral Stenosis

7. Case report 6
• A 53 years old gentleman presented with shortness
of breath on exertion for last 2 years , increasing in
intensity for last 3 months. On examination she is
dysnoeic, pulse-128/min, irregular, BP-100/30 mm
Hg, RR-32/min, diastolic thrill in apex, mid-diastolic
murmur in apical area, early diastolic murmur in left
lower sternal area and systolic murmur in aortic
area. ECG- Atrial Fibrillation, CXR-P/A view-
Cardiomegaly, Echocardiogram-severe mitral
stenosis with Moderate AS with severe AR with
moderate pulmonary hypertension. Patient
underwent DVR and she is doing well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
7
Mitral Stenosis

8. Case report 7
• A 42 years old lady presented with sudden weakness on right
side of the body with shortness of breath on exertion for last
6 years. She was treated with anti-asthmatic drugs. On
examination she is dysnoeic, pulse-130/min, irregular, BP-
110/80 mm Hg, RR-31/min, diastolic thrill in apex, S1 soft P2-
loud, mid-diastolic murmur in apical area best heard in left
lateral position, breath held in expiration, Right sided
hemiplegia. ECG- Atrial Fibrillation, CXR-P/A view-
Cardiomegaly, straightening of left border, double right
border, Echocardiogram-severe mitral stenosis with mild MR
with moderate pulmonary hypertension with Wilkins echo
score-8. CT scan of Brain showed infarction in left parietal
region. Patient underwent PTMC and she referred to
neurologist and physiatrist for care of hemiplegia .
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
8
Mitral Stenosis

9. Case report 8
• A 31 years old lady presented with shortness of
breath on exertion, increasing in intensity for last 2
months. On examination she is dysnoeic, pulse-
105/min, regular, BP-Normal, RR-28/min, systolic
thrill in apex, S1 soft P2-loud, pansystolic murmur
in apical area with radiation to left axilla. ECG-
sinus tachycardia, CXR-P/A view-cardiomegaly ;
Echocardiogram-Severe mitral regurgitation with
moderate pulmonary hypertension. Patient being
treated with MVR and she is doing well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
9
Mitral Stenosis

10. Case report 9
• A 34 years old lady presented with shortness of
breath on exertion. On examination she is
dysnoeic, pulse-115/min, regular, BP-Normal, RR-
31/min, systolic thrill in apex, S1 soft, P2-loud,
pansystolic murmur in apical area with radiation to
left axilla. ECG-sinus tachycardia, CXR-P/A view-
cardiomegaly ; Echocardiogram-Severe mitral
regurgitation with moderate pulmonary
hypertension. Patient being treated with Mitral
valve repair and she is doing well.
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
10
Mitral Stenosis

11. Case report 10
• A 44 years old lady presented with shortness of
breath on exertion, swelling of abdomen and legs. She
was being treated with anti asthmatic drugs. On
examination she is dysnoeic, pulse-110/min, regular,
BP-Normal, RR-30/min, diastolic thrill in apex, S1 loud
P2-loud, mid-diastolic murmur in apical area best
heard in left lateral position, breath held in expiration,
ascites in abdomen and hepatomegaly. JVP-raised.
ECG-sinus tachycardia, CXR-P/A view-straightening of
left border, double right border, Echocardiogram-
severe mitral stenosis with severe pulmonary
hypertension with Wilkins echo score-8. She was
diagnosed as CCF with Pulmonary Hypertension due
to MS. Patient treated conservatively and later on
underwent PTMC and she is doing well now .
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
11
Mitral Stenosis

12. Case report 11
• A 54 years old lady presented with swelling of
abdomen and legs and shortness of breath on
minimal exertion. On examination she is dysnoeic,
pulse-130/min, irregular, BP-Normal, RR-33/min,
diastolic thrill in apex, S1 soft P2-loud, mid-diastolic
murmur in apical area best heard in left lateral
position, breath held in expiration, ascites in
abdomen and hepatomegaly. JVP-raised. ECG-sinus
tachycardia, CXR- cardiomegaly, Echocardiogram-
Valvular cardiomyopathy(EF-25%, dilated LA and LV)
with severe mitral stenosis with severe pulmonary
hypertension with Wilkins echo score-14. Patient
treated conservatively and she is doing well now .
8/13/2019
Col. Malek Medical College, Manikganj
drtoufiq19711@yahoo.com
12
Mitral Stenosis