Mitral Stenosis: Symptoms, Signs, and Homeostatic Disturbance

Mitral Stenosis
History: A 30-year-old male from a low socioeconomic background presented with one-year
history of worsening exertional dyspnoea and orthopnoea (difficulty of breathing on
exertion and while lying supine, respectively) and swelling of both lower limbs. He also
noticed hoarseness and palpitations. He had rheumatic fever when he was young. He
admitted to intravenous drug abuse in the past.
Physical examination: He was slim built with a normal blood pressure and an irregular pulse
(heart rate: 95 bpm). Edema of both legs was present. Jugular venous pressure was mildly
raised. The liver was slightly enlarged and palpable below the rib edge. Cardiovascular
examination revealed a loud first heart sound, opening snap and mid diastolic murmur with
presystolic accentuation. The lungs were clear.
Laboratory studies: Electrocardiograph demonstrated sinus rhythm with right bundle branch
block along with evidence of left atrial enlargement. Transthoracic and transoesophageal
echocardiograph confirmed severe rheumatic mitral stenosis.
(1) In the clinical case scenario, which symptoms (experienced by the patient like chest
pain) and signs (observed by another person like swelling or redness) are consistent
with the diagnosis?
In the given scenario, the symptoms consistent with the diagnosis are difficulty in
breathing because of dyspnoea as well as orthopnoea as well as irregular heartbeats.
Oedema is another constant symptom. Heart blockage is evident from the results of the
diagnosis. Thus irregular blood flow is another constant symptom (Sherwood et al.
2014).
(2) Given the symptoms and signs in the clinical case scenario, which organs, tissues
and/or body parts are involved or affected by the homeostatic disturbance?
Since the patient is suffering from dyspnoea and orthopnoea, the lungs are affected
due to the difficulty in breathing. The heart is also not in proper condition as regular

blood flow is interrupted due to blockage. The limbs are affected due to the swelling.
Liver is also affected showing enlargement. Rheumatic fever is indicative of poor
immunity system (Shier et al. 2014).
(3) What processes are involved that can explain the homeostatic disturbance/s in the
clinical case scenario?
Homeostatic disturbance due to mitral stenosis:
The respiratory control system usually satisfies the various metabolic requirements of
the body. Homeostasis is maintained by regulation of the oxygen along with carbon dioxide
apart from hydrogen ion concentration along the body tissues and the blood (Elbehairy et al.
2015). Development of dyspnoea is complex in patients as it occurs due to the stimulation of
various mechanoreceptors through the lungs upper-respiratory ways along with the
increased load on the system (Torres and Chen 2016). The load on the respiratory system
usually is due to increased airway resistance along with decreased chest wall compliance. In
case of dyspnoea this ratio is not maintained as a result of which homeostasis is affected
(Schneckenpointner et al. 2015).
Congestive heart failure leads to disruptions in homeostasis. There is an imbalance
of the calcium and magnesium ions which causes dyshomeostatsis. This imbalance is
caused due to RAAS activation along with hyperparathyroidism with disrupted
hypocalcaemia and hypomagnesemia (Hartupee and Mann 2017).
The dyshomeostatisis causes hypozincemia and hyposelenimia which cause antioxidant
deficiencies causing cardiomyocyte necrosis along myocardial osmotic based destruction of
the mitochondrial membrane transition pore along with organelle destruction. Homeostatic
control systems are usually of three types consisting of main components of a receptor, an
integrating centre along with the effector. There is a constant functioning of the positive as
well as the negative feedback loops which brings the system back to the normal process of
functioning. There are various adjustments of metabolism, blood pressure as well as body
temperature which are negative feedback (Lakhal-Littleton et al. 2015).
In the following case study, the following patient is suffering from a disease
characterised by irregular blood flow due to due to which mitral stenosis has been seen in
the circulatory system. Mitral stenosis occurs when there is obstruction in the regular flow of
blood from the left atrium to the left ventricle (Ayoub et al. 2017). It usually results from the
disease known as rheumatic fever and in the case study it can be seen that the patient has