Mitral Stenosis Case Study

Case Study:- 

Case Background:- 

The patient is 58 year old male having past medical history of  Rheumatoid fever ,CAD/RHD, DM and HTN was admitted to SS hospital on 11/09/23 due to Shortness of Breath ,palpitation and chest pain .On the basis clinical evaluation and further Investigations like ECG,Echo,CAG And blood Investigations he was diagnosed that he has severe mitral valve stenosis. so,On 19/09/23 A surgical procedure Mitral valve reolacement was done .

Case Introduction :- 

Mitral stenosis (MS) is a form of valvular heart disease characterized by the narrowing of the mitral valve orifice. The most common cause of mitral valve stenosis is rheumatic fever,

The prevalence of rheumatic disease in developed countries is declining, with an estimated incidence of 1 in 100,000. The prevalence is higher in developing nations than in the United States.

Rheumatic mitral stenosis is more common in females. The onset is usually between the third and fourth decades of life.

Mitral stenosis presents 20 to 40 years after an episode of rheumatic fever. The most common symptoms are orthopnea and paroxysmal nocturnal dyspnea. 

 Patients may have symptoms of palpitations, chest pain, hemoptysis,fatigue and weakness.

On auscultation, the first heart sound is usually loud and maybe palpable due to increased force in closing the mitral valve. 

Clinical Presentation:-

 

Palpitation

Chest pain

Orthopnea

orthopnea and paroxysmal nocturnal dyspnea

fatigue and weakness

On Ausculttion there's 

murmour sound 

Investigation :- 

ECG( For Arrythmias)

Chest X ray( For Cardiomegaly)

Echocardiography(Dog leg or hockey stick appearence)

Cardic Cathetrization

Treatment:-

Medical therapy,(Preventive) 

percutaneous mitral valvuloplasty, and surgical therapy..

Mitral valve replacement

Prognosis:-

 Mitral valve stenosis can remain asymptomatic for years, especially when resulting from rheumatic fever.Once symptoms become apparent, the progression of the disease generally accelerates, particularly when it is secondary to rheumatic fever.an overall 30-day mortality of about 10.3% in isolated mitral valve surgery. 

SUBJECTIVE ASSESSEMENT:-

.Demographic Data:-

Name:- XYZ

Age:- 58/M

Occupation:- Shope keeper 

Address:-Shivaji nagar Indore MP 

Hand Dominence:- Right

Date of Admission:- 11/09/23

Date of Surgery :- 19/09/23

Date of Evaluation :- 20/09/23

Cheif Complain :- The patient has Breathing Difficulty and swelling in B/L lower limb.

History of presenting illness:- 

Dysapnea:- Associated with Orthopnea.

Pedal Oedema.

Cough and restlessness:- 

Onset  - Gradual 

Duration:- Persistrnt(>3weeks)

Nature:- Productive 

  

Associated symptoms:-

Breathlessness :- Present ( FiO2- 60%,SpO2-96)

                                      NYHA:- IV 

Cough :- Present

Sputum :- Present 

Fever :- Absent 

Past Medical History :-

 HTN (7 yrs)

DM (5 yrs)

Throat infection and rheumatoid fever at age of 26 than he further experience the same 3 month back.

Surgical History :-

Mitral valve replacement( 19/09/23)

Carbomedics mechanical bileafted mitral Valve has been implant via open heart surgery through mid sternotomy.

  Personal History :- 

He lives healty livestyle and on healthy diet .

Occassional  drinker

On balanced and mixed diet before the condition.

Bladder and bowel was regular before the condition but now on catheter.

Family History:- no significant present 

Medication History :- 

Inj.Meropenem

Inj Atropin

Inj clindamycine

T Vancomycine

T. Pantop etc.

Envioronmental History :- He lives in  Hygienic condition.

Socioeconomic history:- Upper middle class

OBJECTIVE  ASSESSEMENT:-

Vitals:- Fio2:-60%

            Spo2:-95%

            BP:-140/95

            HR:-85BPM

            RR:-  18 Breath per minute

On Inspection:- 

• Body Built :- ectomorphic
• Type of Skin :- Hydrated 
•  Type of Ventilation :- supplemental 
•    oxygen( Via supplemental oxygen by nasal canula ).
• Level of Conciousness:- E4V0M6 :-normal
• External Appliences :- Catheter,ECG leads,BP cuff,Pulse oximeter, center line,ventilation , drainage tube.
• Cynosis:- Absent
• Clubbing of Nails:- Present
• Jugular Venous Pressure:- Normal
• Chest Symmetery:- Present
• Involuntary Movements:- Absent 
• Type of Breathing :-Abdominal breathing
•   Scars:-present(mid sternum) 
• Bandage:-chest binder
• Disability level:-Bedridden

On Palpation:- 

Trachea:- slightly deviated to right side

Chest Expansion:-Minimum

Temperature Variation of Skin:-absent

Apex beat:- present

Vocal fremitus:- Normal 

Auscultation:- 

Breath sounds:-

There’s decrease air entery  in right upper and middle lobe and left middle lobe and also there’s  coarse crackles in  left lower lobe .

Heart Sound:-S1 And S2 present.

Outcome Measures:-

 NYHA(New York Heart Association) Classification

Heart Quality of life Questionair

Physiotherapy Management:-

GOALS:- 

Short  term:- 

To educate patient and attender about the condition and its prognosis & treatment. 

 To prevent secondary complications.

 To Improve breathing capacity and remove lungs Secretions.

Make able the patient to do his transfer activity and ambulation.

Long  term:-

Make able the patient to do functional  activities.

Return to work.

References :- 

https://www.physio-pedia.com/Cardiac_Valve_Defects.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861980/.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340911/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750129/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757865/