A 40-year-old woman with a history of rheumatic fever presents with shoness of breath, weight loss, fatigue and abdominal distension. Physical examination shows rales in the lungs, hepatosplenomegaly and 2+ pitting edema of the legs. A chest X-ray reveals only left atrial enlargement and pulmonary edema. What is the most likely cause of pulmonary edema in this patient?
* The mitral valve is the most commonly and severely affected valve in chronic rheumatic disease. * Chronic rheumatic valvulitis is characterized by irregular thickening and calcification of the leaflets, with fusion of the commissures and chordae tendineae -the valve orifice becomes reduced to a "fish mouth" or "buttonhole"stenosis *The pressure in the left atrium rises and is transmitted the pulmonary veins to the pulmonary vasculature. -Image shows Rheumatic vegetation on mitral valve in chronic rheumatic disease -Image shows "fish mouth" or "buttonhole"stenosis * In cases of aoic insufficiency or stenosis, the left atrium is initially protected by closure of the mitral valve. The other choices are not associated with atrial enlargement or pulmonary edema.
Aoic insufficiency
Aoic stenosis
Mitral stenosis
Tricuspid insufficiency
Rheumatic Fever