Mitral Stenosis: A Comprehensive Case Study on Health and Homeostasis

This case study presents a 30-year-old male with mitral stenosis, a condition resulting from past rheumatic fever and complicated by intravenous drug abuse. The patient exhibits symptoms such as exertional dyspnoea, orthopnoea, lower limb edema, hoarseness, and palpitations. Physical examination reveals an irregular pulse, elevated jugular venous pressure, and a distinctive heart murmur. The study identifies the heart and lungs as primary organs affected by the homeostatic disturbance, detailing how mitral valve narrowing disrupts blood flow, leading to pulmonary hypertension and potential heart failure. The case further explains the processes involved, including the thickening of mitral valve leaflets due to rheumatic fever, the resulting abnormal blood flow, and the potential for complications such as atrial fibrillation and thromboembolism. The document concludes by referencing various research articles supporting the understanding and analysis of mitral stenosis.

HEALTH AND HOMEOSTASIS
HEALTH AND HOMEOSTASIS
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HEALTH AND HOMEOSTASIS
Case: 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.
Templete:
(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?
The main symptom of the patient who is diagnosed with rheumatic mitral stenosis is:
 Severe chest pain.
 Swelling on his feet which are called as edema (Mahmoud ET AL. 2018).
 Abnormalities in respiratory system. Troubled breathing which is called as dyspnoea.
 Rapidly increasing heart rate. Palpitated heart.
 Fatigue.
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HEALTH AND HOMEOSTASIS
In this case study the diagnosis of this patient is:
 He is suffering with troubled breathing
 His heart rate is rapidly increasing. He has palpable heart now (Nakamura et al.
2016).
 He has edema on his feet.
(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?
In case of the rheumatic mitral valve stenosis heart is mostly affected with this disease. Mitral
valve is the very important part of heart which helps the blood circulation throughout the
body (Wunderlich et al. 2019). Thus total cardiovascular system got affected. In the other
hand lungs are also get affected due to this disease. Pulmonary hypertensive positions are
found due to this disease. As irregular blood circulation condition comes muscles are also got
affected for this disease (Iung, Leenhardt and Extramiana 2018).
(3) What processes are involved that can explain the homeostatic disturbance/s in the
clinical case scenario?
The rheumatic mitral valve stenosis condition occurs when a person had been suffered with
rheumatic fever once. This condition generally described as narrowing of the mitral valve of
heart and interrupted blood flow inside the heart (Kim et al. 2015). Our heart is made up of
four particular chambers, two of the upper portions are called as atria and rest two lower
portions are called as ventricles. This left side of the heart which have one atria and one
ventricle are divided by mitral valve. Mitral valve is consists of two small tissues which are
called as leaflets. Due to the rheumatic fever the leaflets of the mitral valve getting thickened,
thus the passage of the blood flow through the mitral valve become narrowed. In normal
cases during blood flow this mitral valve of the heart opens when blood flows from left
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HEALTH AND HOMEOSTASIS
atrium to left ventricle (Esteves et al. 2017). Then those two small tissues which are called as
leaflets close. These two small tissues prevent the blood flow to the opposite direction. In
case of mitral valve stenosis we can see that the leaflets are thickened de to rheumatic fever
thus they neither opens properly nor fully closed. Thus the blood cannot flow with its proper
way. The contractions on atria and ventricles only happen when blood circulation process
happens properly. In the normal scenario when blood flows through the atria toward ventricle
the atria become squeezed in size which we consider as a contraction. Same will happens in
case of ventricles also (Nishimura et al. 2016). But in case of mitral valve stenosis no
contraction occurs due to abnormal blood flow through the left atrium towards ventricle. As
we all know heart is the main organ who supplies blood throughout the body. Thus when
mitral stenosis condition occurs the valve does not open properly so the blood flow become
irregular. Thus the whole system got affected due to this condition. For this reason swelling
occurs on feet as the blood cannot reach properly to those places. Blood also cannot reach to
the lungs, for this reason pulmonary hypertension occurs (Venkateshvaran et al. 2015). This
mitral stenosis leads the heart towards heart collapse, which we called as cardiac failure.
Stroke also occurs due to this condition. Sometimes left atrium enlarges due to this condition
which leads the heart towards atrial fibrillation. This condition is responsible for the
thromboembolis (Jellis and Yingchoncharoen 2015). This condition generally clots the blood
inside heart. In normal cases blood clotting never occurs inside heart because of the presence
of thrombosis in the vein. But in such condition thrombosis does not work properly to prevent
the clotting condition. In such cases heart rate become faster and as the left atrium does not
contract properly the the heartace strats tor bother the patient. In this case study this person
was addicted to restricted drugs in past. These restricted drugs also responsible for this
condition (Esteves et al. 2017). This kind of condition increases the risk of various other life
threating symptoms which are as follows:
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HEALTH AND HOMEOSTASIS
Heart failure: as we can see the passage of the blood flow through mitral valve become
narrowed the blood flow become irregular and interfered. This will increase the pressure
inside heart and lungs and the intravenous fluid become accumulated inside heart. Those
fluids create huge strains into heart and heart failure occurs (Mishra et al. 2016).
Blood clot: Because of the atrial fibrillation these blood clot conditions occur.
References:
Esteves, W.A.M., Lodi-Junqueira, L., Soares, J.R., Athayde, G.R.S.A., Goebel, G.A.,
Carvalho, L.A., Zeng, X., Hung, J., Tan, T.C. and Nunes, M.C.P., 2017. Impact of
percutaneous mitral valvuloplasty on left ventricular function in patients with mitral stenosis
assessed by 3D echocardiography. International journal of cardiology, 248, pp.280-285.
Iung, B., Leenhardt, A. and Extramiana, F., 2018. Management of atrial fibrillation in
patients with rheumatic mitral stenosis. Heart, 104(13), pp.1062-1068.]
Jellis, C. and Yingchoncharoen, T., 2015. Assessment of Mitral Valve Function. In An Atlas
of Mitral Valve Imaging (pp. 17-30). Springer, London.
Kim, H.W., Moon, M.H., Jo, K.H., Song, H. and Lee, J.W., 2015. Left atrial and left
ventricular diastolic function after the maze procedure for atrial fibrillation in mitral valve
disease: degenerative versus rheumatic. Indian Journal of Surgery, 77(1), pp.7-15.
Mahmoud Elsayed, H.M., Hassan, M., Nagy, M., Amin, A., Elguindy, A., Wagdy, K. and
Yacoub, M., 2018. A novel method to measure mitral valve area in patients with rheumatic
mitral stenosis using three‐dimensional transesophageal echocardiography: Feasibility and
validation. Echocardiography, 35(3), pp.368-374.
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Mishra, A., Kumar, B., Dutta, V., Arya, V.K. and Mishra, A.K., 2016. Comparative effect of
levosimendan and milrinone in cardiac surgery patients with pulmonary hypertension and left
ventricular dysfunction. Journal of cardiothoracic and vascular anesthesia, 30(3), pp.639-
646.
Nakamura, K., Elmariah, S., Pomerantsev, E., Leavitt, M., Inglessis, I., Palacios, I. and
Passeri, J., 2016. ECHOCARDIOGRAPHIC ASSESSMENT OF CALCIFIC MITRAL
STENOSIS OVERESTIMATES SEVERITY COMPARED TO RHEUMATIC MITRAL
STENOSIS. Journal of the American College of Cardiology, 67(13 Supplement), p.1700.
Nishimura, R.A., Vahanian, A., Eleid, M.F. and Mack, M.J., 2016. Mitral valve disease—
current management and future challenges. The Lancet, 387(10025), pp.1324-1334.
Venkateshvaran, A., Sola, S., Govind, S.C., Dash, P.K., Barooah, B., Shahgaldi, K., Sahlén,
A., Lund, L., Winter, R., Nagy, A.I. and Manouras, A., 2015. The impact of arterial load on
left ventricular performance: an invasive haemodynamic study in severe mitral stenosis. The
Journal of physiology, 593(8), pp.1901-1912.
Wunderlich, N.C., Dalvi, B., Ho, S.Y., Küx, H. and Siegel, R.J., 2019. Rheumatic Mitral
Valve Stenosis: Diagnosis and Treatment Options. Current cardiology reports, 21(3), p.14.
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