Valvular Heart Disease — Mitral Stenosis

In mitral stenosis, the opening snap occurs at which point in the cardiac cycle and is caused by which mechanism?

Which of the following is the most common cause of mitral stenosis in India and other developing countries?

A 32-year-old woman with rheumatic mitral stenosis (MVA 1.2 cm²) presents with palpitations and dyspnea on exertion. She is in normal sinus rhythm with a heart rate of 88 bpm. Echocardiography confirms severe MS with preserved left ventricular function. She is not a candidate for percutaneous mitral commissurotomy at this time. What is the drug of choice for symptomatic relief and rate control in this patient?

The pressure-volume loop shown above compares a control heart with a heart affected by mitral stenosis. Which of the following changes is characteristic of the mitral stenosis loop compared to the control loop?

A 28-year-old woman from rural Maharashtra presents with progressive dyspnea on exertion and palpitations for 6 months. She has a history of acute rheumatic fever at age 12. On examination, she is in sinus rhythm with a pulse of 88/min and BP 118/76 mmHg. Auscultation reveals a loud S1, an opening snap 80 ms after A2, and a low-pitched diastolic murmur at the apex. Chest X-ray shows straightening of the left heart border and pulmonary edema. Echocardiography demonstrates a mitral valve area of 1.2 cm². What is the most appropriate next step in management?