Differential Diagnosis for Rheumatic Mitral Valve Stenosis

When considering a diagnosis of rheumatic mitral valve stenosis, it's crucial to evaluate the clinical presentation, echocardiographic findings, and patient history to differentiate it from other potential causes of mitral stenosis or similar clinical presentations. Here's a structured approach to the differential diagnosis:

• Single Most Likely Diagnosis

  • Rheumatic heart disease: This is the most common cause of mitral stenosis worldwide, especially in developing countries. A history of rheumatic fever, along with characteristic echocardiographic findings such as leaflet thickening, commissural fusion, and chordal shortening, supports this diagnosis.

• Other Likely Diagnoses

  • Degenerative mitral stenosis: This condition can mimic rheumatic mitral stenosis but is more common in elderly patients and is associated with calcification of the mitral valve.
  • Mitral annular calcification: This can cause mitral stenosis, especially in patients with chronic kidney disease or older adults, and is characterized by calcification of the mitral annulus.
  • Congenital mitral stenosis: Although rare, this condition can present in childhood or adulthood and is due to abnormalities in mitral valve development.

• Do Not Miss Diagnoses

  • Infective endocarditis: While not a direct cause of mitral stenosis, infective endocarditis can complicate pre-existing valve disease, including rheumatic heart disease, and has a high mortality rate if not promptly treated.
  • Cardiac tumors (e.g., left atrial myxoma): These can obstruct blood flow and mimic the symptoms of mitral stenosis, such as dyspnea and fatigue.
  • Severe pulmonary hypertension: This can lead to right heart failure and symptoms similar to those of mitral stenosis, such as dyspnea and fatigue, and is critical to diagnose due to its implications for treatment and prognosis.

• Rare Diagnoses

  • Systemic lupus erythematosus (SLE) related valvulopathy: SLE can cause Libman-Sacks endocarditis, which may lead to mitral stenosis, although this is rare.
  • Rheumatoid arthritis associated valvular disease: While more commonly associated with aortic valve disease, rheumatoid arthritis can rarely cause mitral valve pathology.
  • Carcinoid heart disease: This condition, resulting from carcinoid tumors secreting serotonin, can lead to fibrosis of the heart valves, most commonly the tricuspid and pulmonary valves, but rarely can affect the mitral valve.