A 68-year-old woman is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have any symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the nice lady, the nurse would most likely learn that the client’s childhood health history included:
A. Chicken pox
B. Poliomyelitis
C. Rheumatic fever
D. Meningitis
Correct Answer: C. Rheumatic fever
Most clients with mitral stenosis have a history of rheumatic fever or bacterial endocarditis. The most common cause of mitral stenosis is rheumatic fever. Uncommon causes of mitral stenosis are calcification of the mitral valve leaflets and congenital heart disease. Other causes of mitral stenosis include infective endocarditis, mitral annular calcification, endocardial fibroelastosis, malignant carcinoid syndrome, systemic lupus erythematosus, Whipple disease, Fabry disease, and rheumatoid arthritis.
Option A: Chickenpox (varicella) is usually a benign childhood illness, but it can occasionally cause life-threatening complications. Complications related to varicella are mainly neurologic and infectious. Cardiac complications of chickenpox include myocarditis, pericarditis, and rarely infective endocarditis.
Option B: Stenosis of the mitral valve typically occurs decades after the episode of acute rheumatic carditis. Acute insult leads to formation of multiple inflammatory foci (Aschoff bodies, perivascular mononuclear infiltrate) in the endocardium and myocardium.
Option D: A number of conditions can simulate the physiology of mitral stenosis: severe nonrheumatic mitral annular calcification, infective endocarditis with large vegetation, left atrial myxoma, ball valve thrombus, and cor triatriatum.
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