of pulmonary edema. Mitral stenosis, you are
having an issue in
which the orifice between the mitral valve
or between the left atrium and the left ventricle
has become narrowed. Major cause. Rheumatic
heart disease yet once again, so let us just
collectively think about this one more time.
If it is the patient, a child perhaps with
pharyngitis and wasn't properly treated for
the streptococcal infection, two
to four weeks later ended up developing issues
within the heart and you would call that
rheumatic disease, but one thing that I want
to get away from so that you understand the
big picture of rheumatic heart disease is
that only the endocardium that will be affected
by rheumatic heart disease. The operative
word here is heart. Granted, if you are talking
about damage to the valves, then what part
of the heart are you in? Meaning to say in
terms of positioning, you are in the endocardium
so therefore the endocarditis would then give
rise to the valvular heart problems, wouldn't
it? In rheumatic heart disease. But then could
you have issues with the myocardium, myocarditis?
Of course, you could. But that wouldn't lead
into valvular heart disease, but there will
be myocarditits, still part of the heart and
then please do not forget, you can have rheumatic
heart disease in which you could have pericarditis.
So these are things that when we talk about
rheumatic fever as a whole and you are thinking
about rheumatic heart disease as being a component
of what is known as your major Jones criteria.
You remember that? One of them is pancarditis.
What we're dealing with specific and what
we have been dealing with here? Specifically,
it has been the endocarditis component of
rheumatic heart disease. Is that clear?
I hope so.
Now, with endocarditits, taking place due
to rheumatic heart disease early on the damage
is taking place, the valves, what is the topic
here? Stenosis, not early on. Early on it
would be what kind of issues, please? Regurgitation.
What side of the heart are you paying attention
to? Left side. What are they? Aortic and maybe
the mitral regurg issues. Our topic here stenosis
and I have mentioned this a few times, let
us do it once more. When you have repair process
taking place due to damage, which is occuring
here due to rheumatic heart disease, then
the repair process will result in later on
chronically as mitral stenosis. "So Dr. Raj,
you tell me the rheumatic disease that there
could potentially be four different valvular
heart diseases?" That is exactly what I am
telling you. Two of those will be early with
regurgitation. Two of those will be later
on, chronically with stenosis. Right now we
are dealing with mitral stenosis. Let us continue.
Now, the pathophys as the valve area gets
smaller, orifice, where is that going to
be more work? Left atrium. As it increases
the pressure and such in the left atrium,
then please understand how would you measure
this clinically? PWCP. Pulmonary Wedge Capillary
Pressure. And there would a Swan-Ganz
catheter in which once it get wedged in your
pulmonary blood vessels, you are going
to be measuring the pressure where? Downstream
and so, therefore, can you expect your left
atrial pressure to be increased? My goodness.
Isn't that the main feature of mitral stenosis?
The pulmonary blood vessels would be affected
and early on you will have pulmonary edema.
That is not a good thing. What does pulmonary
edema mean to you? Shortness of breath, dyspnea