Naushad Hirani BSc, MD
With the falling incidence of rheumatic fever in developed countries, the incidence of mitral stenosis has been steadily declining, although it remains one of the most common valvular lesions in developing nations. This lesion can present for the first time in elderly patients, as it often exists for many years before becoming clinically apparent. Knowledge of the etiology, pathogenesis, diagnosis, and treatment of this once common disease would be useful to any physician dealing with geriatric patients.
Etiology & Pathophysiology
The predominant cause of mitral stenosis (MS), as already alluded to above, is rheumatic fever, although there are several rare causes. Acute rheumatic fever itself is diagnosed using the Jones criteria, but often goes undiagnosed in young people. It is not therefore surprising that a reliable history is usually difficult to obtain and that the history is not the best guide as to the likelihood of the disease being present. The mechanisms by which the disease process is initiated remain controversial. It may be a slowly progressive autoimmune inflammatory reaction which begins with the illness and takes many years to become clinically significant, or it may be that the initial insult causes a deformity that with subsequent constant trauma due to turbulence leads to fibrosis, thickening, and calcification of the valve.
