Rheumatic Heart Disease

A 28-year-old woman from rural Maharashtra presents with progressive dyspnea on exertion for 6 months and orthopnea. She has a history of recurrent sore throat in childhood. On examination, she has an irregular pulse (90–110 bpm), a loud S1, an 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 straightening of the left heart border and pulmonary congestion. Echocardiography reveals a thickened, domed mitral valve with restricted leaflet motion and a valve area of 1.2 cm². What is the most likely diagnosis?

In chronic rheumatic mitral stenosis, which histological change in the valve leaflet is responsible for the 'fish-mouth' appearance seen on gross examination?

A 28-year-old woman from rural India presents with dyspnea and palpitations. Echocardiography reveals mitral stenosis with a thickened, calcified valve. Which is the most common valve involved in chronic rheumatic heart disease?

A 28-year-old woman from rural India presents with dyspnea on exertion and orthopnea for 3 months. On examination, she has an opening snap, diastolic murmur at the apex, and signs of pulmonary edema. Chest X-ray shows cardiomegaly and pulmonary congestion. Echocardiography confirms mitral stenosis with a valve area of 1.2 cm². She is currently on diuretics and digoxin. What is the most appropriate next step in management?

A 35-year-old man with established rheumatic mitral stenosis and a history of acute rheumatic fever presents for long-term prophylaxis to prevent recurrent streptococcal infection and further cardiac damage. He has no penicillin allergy. What is the drug of choice for secondary prophylaxis in this patient?