Mitral Stenosis Differential Diagnoses
- Author: Claudia Dima, MD, FACC; Chief Editor: Richard A Lange, MD, MBA more...
Pregnant women with mild-to-moderate mitral stenosis can almost always be managed with judicious use of diuretics and beta blockade.
Pregnant women with severe mitral stenosis who are symptomatic before conception will not predictably tolerate the hemodynamic burden of pregnancy and should be considered for percutaneous balloon mitral valvotomy before conception provided the valve is anatomically suitable.
Patients with severe mitral stenosis who develop NYHA functional class III–IV symptoms during pregnancy should undergo percutaneous balloon valvotomy.
Other conditions to be considered in patients with suspected mitral stenosis include the following:
- Left atrial myxoma
- Ball valve thrombus
- Massive mitral annular calcification
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|Category||Duration After Last Attack||Rating*|
|Rheumatic fever with carditis and residual heart disease (persistent valvular disease† )||10 y or until age 40 y (whichever is longer); sometimes lifelong prophylaxis||IC|
|Rheumatic fever with carditis but no residual heart disease (no valvular disease† )||10 y or until age 21 y (whichever is longer)||IC|
|Rheumatic fever without carditis||5 y or until age 21 y (whichever is longer)||IC|
|*Rating indicates classification of recommendation and level of evidence (eg, IC indicates Class I, level of Evidence C).|
†Clinical or echocardiographic evidence.
|Benzathine penicillin G||Children 27 kg (60 lb): 600,000 U|
Patients >27 kg: 1,200,000 every 4 wk†
|Penicillin V||250 mg bid||Oral||IB|
|Sulfadiazine||Children 27 kg: 0.5 g qd|
Patients >27 kg: 1 g qd
|Macrolide or azalide (for individuals allergic to penicillin and sulfadiazine)||Variable||Oral||IC|
|*Rating indicates classification of recommendation and level of evidence (eg, IA indicates Class I, level of Evidence A).|
†In high-risk situations, administration every 3 weeks is justified and recommended.
|Penicillin V (phenoxymethyl penicillin)||Children 27 kg (60 lb): 250 mg bid or tid |
Patients >27 kg: 500 mg bid or tid
|Amoxicillin||50 mg/kg qd (maximum 1 g)||Oral||10 d||IB|
|Benzathine penicillin G||Children 27 kg (60 lb): 600,000 U |
Patients >27 kg: 1,200,000 U
|For individuals allergic to penicillin|
|Narrow-spectrum cephalosporin (cephalexin, cefadroxil)||Variable||Oral||10 d||IB|
|Clindamycin||20 mg/kg/d divided in 3 doses (maximum 1.8 g/d)||Oral||10 d||IIaB|
|Azithromycin||12 mg/kg qd (maximum 500 mg)||Oral||5 d||IIaB|
|Clarithromycin||15 mg/kg/d divided bid (maximum 250 mg bid)||Oral||10 d||IIaB|
|*Sulfonamides, trimethoprim, tetracyclines, and fluoroquinolones are not acceptable.|
† Rating indicates classification of recommendation and level of evidence (eg, IB indicates Class I, level of Evidence B)