Valvular Heart Disease

A 38-year-old woman from Mumbai with a history of acute rheumatic fever at age 12 presents with palpitations and dyspnea on exertion. On examination, she has an opening snap followed by a mid-diastolic murmur at the apex. Echocardiography shows mitral stenosis with a valve area of 1.2 cm² and mean gradient of 18 mmHg. Left atrial diameter is 5.2 cm. She is in normal sinus rhythm. She has no prior history of atrial fibrillation or thromboembolism. What is the most appropriate next step in management?

A 35-year-old woman from rural Uttar Pradesh presents with dyspnea on exertion and orthopnea. Echocardiography shows severe aortic regurgitation with aortic root dilatation. What is the most common underlying cause of aortic regurgitation in this clinical context?

Which of the following is the most common cause of acute rheumatic fever (ARF)-induced mitral stenosis in India?

A 58-year-old man from rural India presents with progressive dyspnea on exertion and orthopnea for 3 months. He has a history of acute rheumatic fever (ARF) at age 12. On examination, he has an irregular pulse (90 bpm), elevated JVP, hepatomegaly, and bilateral ankle edema. Auscultation reveals a loud S1, opening snap at the apex, and a low-pitched diastolic murmur best heard at the apex in the left lateral decubitus position. Chest X-ray shows pulmonary congestion and straightening of the left heart border. ECG shows atrial fibrillation with a ventricular rate of 92 bpm and left atrial enlargement. What is the most likely diagnosis?

Regarding the pathophysiology and clinical features of mitral stenosis, all of the following are true EXCEPT: