Name of the Condition

• Rheumatic Mitral Stenosis with Insufficiency
• Also known as Rheumatic Mitral Valve Disease

Summary

Rheumatic mitral stenosis with insufficiency is a heart condition characterized by the narrowing and improper closure of the mitral valve due to rheumatic fever. This leads to restricted blood flow from the left atrium to the left ventricle and backflow of blood, causing significant strain on the heart.

Causes

• The primary cause is rheumatic fever, an inflammatory disease that can develop following untreated streptococcal throat infections.
• The condition results from damage to the heart valves, particularly the mitral valve, due to this inflammatory process.

Risk Factors

• History of rheumatic fever
• Repeated streptococcal infections
• Poor access to medical care leading to untreated streptococcal infections
• Genetic predisposition, as familial patterns may influence susceptibility to rheumatic fever.

Symptoms

• Shortness of breath, especially during exertion or when lying down
• Fatigue and weakness
• Palpitations or irregular heartbeats
• Swelling in the legs and feet (edema)
• Chest discomfort or pain

Diagnosis

• Echocardiogram to evaluate the structure and function of the mitral valve
• Electrocardiogram (ECG) to detect electrical activity abnormalities
• Chest X-ray to view heart size and pulmonary congestion
• Cardiac MRI or CT for detailed imaging

Treatment Options

• Medications: Diuretics to reduce fluid accumulation, anticoagulants to prevent clots, beta-blockers or calcium channel blockers to control heart rate.
• Surgical Interventions: Mitral valve repair or replacement through open-heart surgery or minimally invasive techniques.
• Balloon Valvotomy: Non-surgical procedure to widen the narrowed valve.

Prognosis and Follow-Up

• With proper treatment, patients can manage symptoms effectively and improve quality of life.
• Regular follow-ups are crucial to monitor valve function and heart health.
• Ongoing risk of complications necessitates compliance with management plans.

Complications

• Heart failure due to persistent strain on the heart
• Atrial fibrillation, increasing the risk of stroke
• Pulmonary edema or high blood pressure in the lungs
• Infective endocarditis, an infection of the heart valves

Lifestyle & Prevention

• Regular monitoring and management of heart health
• Prompt treatment of streptococcal infections
• Maintaining a heart-healthy diet and engaging in regular exercise
• Avoiding activities or substances that exacerbate heart symptoms

When to Seek Professional Help

• Sudden or severe shortness of breath
• Chest pain
• Fainting spells or dizziness
• Signs of heart failure, such as severe swelling in the legs or feet

Additional Resources

• American Heart Association (www.heart.org)
• National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov)
• Support groups for individuals with rheumatic heart disease

Tips for Medical Coders

• Verify the history of rheumatic fever when coding this condition.
• Ensure coding reflects both stenosis and insufficiency of the mitral valve.
• Avoid conflating with non-rheumatic mitral valve disorders, as treatment and management may differ.