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• W4387249663 abstract "SESSION TITLE: Cardiovascular Abnormalities and Interventions SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/11/2023 09:40 am - 10:25 am INTRODUCTION: Rheumatic Heart Disease (RHD) remains a major cause of cardiovascular disease in resource-limited nations. Symptoms include fever, joint pain, chorea, and valvular heart disease. Diagnosis is made with history of previous strep infections and echocardiogram. If valvular damage is severe, surgical repair is considered. Here we present a case of a 55-year-old male who presented with hemoptysis, found to have severe mitral stenosis (MS) secondary to RHD. CASE PRESENTATION: A 55-year-old man with a history of paroxysmal atrial fibrillation presented to his primary care physician with a chief complaint of hemoptysis. Denied any history of travel outside of the United States and previous smoking.Endorsed multiple recurrent sore throat infections as a child which were never treated with antibiotics. Born in the United States, never traveled out of the country, and denied any history of intravenous drug use. CBC and CMP were both unremarkable. Neuro exam: CN II-XII intact. Cardio: Grade III/VI diastolic murmur located at the 4th-5th midclavicular line. Resp: Clear breath sounds b/l.Abd: No tenderness to palpation.Echo: Severe mitral valve stenosis with valve morphology consistent with rheumatic disease. The Mitral Valve Area was measured to be 1.3 cm2 (Figure 1 and 2). Started on Warfarin and was referred to cardiothoracic surgery for a mitral valve replacement and Maze Procedure. Underwent mitral valve replacement and Maze Procedure. Intraoperatively, the left atrium was noted to be between 7 to 8 cm in maximal diameter. The mitral valve was heavily calcified, especially in the posterior leaflet. Transesophageal echocardiogram demonstrated severe mitral stenosis. A mechanical mitral valve prosthesis was placed, and the left atrial appendage was removed. The patient tolerated the procedure well without any immediate complications; however, he developed junctional rhythm the following day which resolved. Warfarin was restarted with a goal INR of 3.0. A repeat echocardiogram one month later demonstrated resolution of the MS, and normal function of the mitral valve prosthesis. DISCUSSION: RHD is caused by Rheumatic Fever (RF), which starts as a sore throat from a bacterium known as Streptococcus pyogenes, and occurs mainly in childhood. Repeat infections can cause the immune system to react against the tissues of the body which causes inflammation and scarring of the heart valves. RHD caused by RF is a relatively rare phenomenon that has a prevalence of 0.04/1000 in the USA, and 18.6/1000 globally [2,3]. Mitral stenosis is a common complication of RHD. Mitral valve replacement surgery is indicated in patients with symptomatic moderate or severe MS [4]. After mechanical valve procedure for MS, INR of 2.5 to 3.5 is recommended [5]. CONCLUSIONS: We would like to mention the rare incidence of RHD in a patient born in the United States. Given the extremely low prevalence of RHD in the United States, especially with no known travel history, we present a case of a patient with recurrent untreated sore throat infections as a child who presented with hemoptysis. Physicians should be aware of RHD presentation, diagnosis workup, and treatment. REFERENCE #1: Kumar RK, Tandon R. Rheumatic fever & rheumatic heart disease: the last 50 years. Indian J Med Res. 2013 Apr;137(4):643-58. PMID: 23703332; PMCID: PMC3724245 REFERENCE #2: Woldu B, Bloomfield GS. Rheumatic Heart Disease in the Twenty-First Century. Curr Cardiol Rep. 2016 Oct;18(10):96. doi: 10.1007/s11886-016-0773-2. PMID: 27566329; PMCID: PMC9067597. REFERENCE #3: Eisenberg MJ. Rheumatic heart disease in the developing world: prevalence, prevention, and control. Eur Heart J. 1993 Jan;14(1):122-8. doi: 10.1093/eurheartj/14.1.122. PMID: 8432279. DISCLOSURES: No relevant relationships by Saro Avedikian No relevant relationships by Neil Gerts No relevant relationships by Jeong Hwan Kim No relevant relationships by Mihran Ogaryan No relevant relationships by Jasprit Takher" @default.
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• W4387249663 date "2023-10-01" @default.
• W4387249663 modified "2023-10-03" @default.
• W4387249663 title "RHEUMATIC MITRAL VALVE DISEASE IN THE UNITED STATES: A CASE REPORT" @default.
• W4387249663 doi "https://doi.org/10.1016/j.chest.2023.07.212" @default.
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