Congenital Mitral Stenosis Medication
- Author: M Silvana Horenstein, MD; Chief Editor: Stuart Berger, MD more...
Medical therapy is used to avoid or decrease pulmonary congestion as well as to treat atrial tachyarrhythmias. These require medical therapy to prevent thromboembolic complications.
By promoting renal excretion of water and electrolytes, loop diuretics decrease pulmonary congestion. Pulmonary congestion results from back-flow to the lungs caused by obstruction across a narrowed mitral valve orifice.
Furosemide acts by inhibiting absorption of the electrolytes sodium and chloride in the proximal and distal tubules and in the loop of Henle, thereby promoting excretion of salt (sodium chloride) and water. It acts as a diuretic and as an antihypertensive.
Potassium-sparing diuretics are used to prevent potassium depletion induced by the more potent loop-diuretics (such as furosemide).
Spironolactone retains potassium by competing with aldosterone for the receptor sites in the distal convoluted renal tubules. This increases sodium and water excretion while retaining potassium and hydrogen ions.
Anticoagulants are used in general for the prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. In the case of MS, they are used to prevent clot formation secondary to blood stasis in an enlarged, many times fibrillating, left atrium and in case of a prosthetic (mechanical) mitral valve.
Warfarin inhibits vitamin K–dependent clotting factors II, VII, IX, and X and the anticoagulant proteins C and S. Its anticoagulation effect occurs 24 h after administration, but the peak effect may occur 72-96 h later. Antidotes are vitamin K and FFP.
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