Mitral Valve Stenosis; Treatment!
A 35-year-old woman (gravida 1, para 0) presents to the
emergency room at 32 weeks of pregnancy with complaints of
progressive shortness of breath over the last week and
paroxysmal nocturnal dyspnea for the last 3 weeks. The patient
states that she recently started to use three pillows during sleep.
The patient has a history of atrial fibrillation and uses digoxin for
rate control. She got married two years ago and has been unable
to conceive for more than one year. Her pulse is 120/min and
irregular, and her blood pressure is 130/85 mm Hg. Physical
examination reveals jugular venous distension, bibasilar lung
crackles, a loud S1, an opening snap following S2, and a lowpitched
diastolic murmur best heard in the left lateral decubitus
In the emergency department, the patient receives oxygen via
nasal canula, furosemide 80 mg intravenously, and diltiazem 20
mg intravenously with no significant improvement in her
symptoms. Echocardiography shows normal left ventricular
systolic function with a mitral valve area of 0.9 cm2.
Which of the following is the most effective therapy in her
(A) Initiate therapy with lisinopril
(B) Start metoprolol
(C) Balloon valvuloplasty
(D) Cesarean section
(E) Increase the dose of digoxin
Most effective is baloon valvuloplasty..
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