1) In mitral stenosis a diastolic murmur is present due to stenosis, or narrowing of the valve. The murmur is heard when the mitral valve fails to open appropriately in diastole. The leaflets of the valve are usually thicker, stiffer, and become misshapen from the effects of rheumatic fever or a congenital defect (Porth, 2011). The crackles in her lungs are likely due to left sided heart failure leading to pulmonary hypertension. This causes elevated pulmonary capillary pressure which pushes fluid into the interstitial spaces and alveoli (Bickley & Szilagyi, 2013)
2) Dizziness is a concerning symptom as it may mean her pulmonary hypertension is worsening. Insufficient circulation of blood through the pulmonary capillaries can lead to hypoxemia in persons with respiratory or cardiac disease (Porth, 2011). I would have liked to know what this patient’s pulse oximetry was or if she
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Infective endocarditis is rare, but people with mitral stenosis have a greater risk of developing it. The American Heart Association (AHA) (2015) reports that in the past, patients with a congenital heart defect needed to be treated with an antibiotic one hour prior to dental procedures or operations of the mouth, throat, gastrointestinal genital, or urinary tract. However, in 2007 the American Heart Association changed its recommendations to only prescribing antibiotics before dental procedures in patients with the highest risk of developing infective endocarditis. These new guidelines included patients with prosthetic heart valves, history of endocarditis, a heart transplant with abnormal heart valve function, and certain congenital heart diseases or defects. The AHA (2015) guidelines for preventing infective endocarditis no longer recommend antibiotic treatment for patients who have procedures involving the reproductive, urinary or gastrointestinal