Indranil Dasgupta, MD, MPh, MBA, Clinical Assistant Professor of Medicine, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Marc A. Tecce, MD, Clinical Assistant Professor of Medicine, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Bernard L. Segal, MD, Professor of Medicine and Director, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.

Disorders of the mitral valve such as mitral valve prolapse (MVP), mitral regurgitation, and, to a lesser degree, mitral stenosis are relatively common forms of heart disease. According to the Women’s Heart Foundation, MVP is the most common condition of the heart valves, and while it is more frequently diagnosed in young women, data from the Framingham study suggest that, overall, MVP affects equal numbers of men and women. These conditions often progress over years, frequently causing symptoms among affected older adults. Understanding the etiology, diagnosis, management, and treatment of mitral valve disease is vital for this population. Medical advances and other factors have allowed the general population to live longer, making mitral valve disease significantly more prevalent. An understanding of the details of the physical exam, ECG changes seen in these disorders, x-ray findings, and echocardiographic and catheterization data are critical to providing the necessary standard of care for older adults.
Key words: mitral regurgitation, mitral stenosis, mitral valve prolapse, older adults, heart failure.

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.