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 58-year-old man from Delhi presents with progressive dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea for 3 months. On examination, he has an opening snap followed by a low-pitched diastolic murmur at the apex. Chest X-ray shows pulmonary edema and straightening of the left heart border. Which investigation is most appropriate to confirm the diagnosis and assess severity?

A 52-year-old woman from Mumbai with a history of acute rheumatic fever (ARF) in childhood presents with exertional chest discomfort, syncope, and a systolic ejection murmur best heard at the right upper sternal border that radiates to the neck. Echocardiography shows a bicuspid aortic valve with restricted leaflet opening. Which investigation is most appropriate to assess the hemodynamic severity and guide intervention?

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?