From the Research
Diuresis is recommended in patients with mitral stenosis to reduce pulmonary congestion and alleviate symptoms of heart failure, as it improves morbidity and quality of life, although it does not address the underlying valvular problem 1. The primary goal of diuresis in mitral stenosis is to decrease fluid volume in the circulation, which reduces left atrial pressure and pulmonary venous pressure.
- Loop diuretics such as furosemide (20-40mg orally once or twice daily) or bumetanide (0.5-1mg daily) are typically the first-line agents.
- These medications work by decreasing fluid volume in the circulation, which reduces left atrial pressure and pulmonary venous pressure. In mitral stenosis, the narrowed mitral valve impedes blood flow from the left atrium to the left ventricle, causing blood to back up in the left atrium and pulmonary veins.
- This leads to pulmonary congestion, manifesting as dyspnea, orthopnea, and pulmonary edema.
- By reducing intravascular volume, diuretics decrease the pressure gradient across the stenotic valve and improve symptoms. Potassium levels should be monitored regularly, and potassium supplementation may be necessary.
- Diuretic therapy should be adjusted based on symptom improvement, weight changes, and signs of fluid retention. While diuretics provide symptomatic relief, they do not address the underlying valvular problem, so definitive treatment with valve repair or replacement should be considered for severe or symptomatic mitral stenosis, as it improves mortality 1. The use of diuretics in patients with mitral stenosis is supported by studies that demonstrate their effectiveness in reducing fluid overload and improving symptoms, although the most recent and highest quality study 2 suggests that a combination of diuretics and aquaretic agents may be more effective in achieving euvolemia rapidly and without electrolyte disturbances. However, the use of diuretics should be individualized and based on the patient's specific needs and response to treatment, as well as consideration of potential side effects and interactions with other medications 3, 4.