Rheumatic mitral stenosis
From anamnesis: N.I.K., 55 years old woman joins in the Cardiology ward with complaints of severe constriction, accompanied by a cough with expectoration of rusty sputum, weakness and anorexia. Immediately before entering in the ward the patient receives acute pain in the right chest half, accompanied by haemoptysis. The patient reports that when she is lying oh her right side her pain decreased in intensity. When she inhales deeply pains are amplified, as they are accompanied by stabbing in the right chest and attacks of cough.
The patient is well known to doctors because is treated many times for chronic heart failure due to rheumatic defect of mitral valve – mitral stenosis. For several years she suffers from diabetes. Her parents died in old age from myocardial infarction and brain stroke.
From status: are establish data for common chronic venous stasis, presented by dilatated jugular veins, moderate enlargement of liver and spleen, ascites and edema of the lower limbs. Irregular heartbeat with characteristic of absolute arrhythmia, but no pulse deficit. The firs tone of the cardiac apex is increased, it is established tone of mitral valve opening. During auscultation is found protodiastolar noise with perisistolic click. On a. pulmonalis the second tone is cleaved and accentuate. In the right chest half is herd pleural friction, and in the pulmonary bases – small moist crepitations.
On the second day the patient gets severe pain in left lumbar area. Renal succussion on the left is positive, and in urine except traces of protein is found microscopic erythrocyturia. Despite the treatment, the patient is getting worse. On day 4 she becomes difficult to contact, and her blood glucose values are moderately increased. Other laboratory tests showed no significant deviations. At the end of the fifth day the patient is found dead.
Clinical diagnosis: Brain-vascular disease: Insultus cerebri regionis art. cerebri mediae sinistri. Diabetes mellitus. Rheumatismus verus – N-attack. Stenosis ostii valvulae mitralis. Insuffitientio cardio-circulatoria chronica gr.ІІІ. Infarctus pulmonis dextri. Pleuritis reactiva dexra. Atherosclerosis generalisata.