Atrial fibrillation with flutter episode in patient with mitral stenosis

Deri Arara,Yerizal Karani

doi:10.25077/mka.v41.i3.p134-142.2018

Abstract

Mitral stenosis (MS) is a condition which happened because of congenital or acquired event. The most common etiology of MS in Indonesia is Rheumatic Heart Disease (RHD). Chronic inflammation on the mitral valve could lead to stenosis from mild to severe degree. Mitral stenosis could lead to many complications such as pulmonary hypertension and atrial fibrillation (AF). The prevalence of AF in patients with MS is related to the severity of valve obstruction and patient age. AF event in patient with MS could be happen because of Left Atrial (LA) dilatation of the patient. The mechanism that responsible for AF in patient with MS is a complex one. AF even with or without atrial flutter episode could lead a deterioration of patient hemodynamic. In the other way, the patient also predisposes to left atrial thrombus formation and systemic embolic events. Good awareness in diagnosis and management of atrial fibrillation in patient with MS are mandatory to reduce the morbidity and mortality.

Highlights

Valvular heart disease accounts for 10% to 20% of all cardiac surgical procedures in the United States
Premature atrial activation, caused by an automatic focus or re-entry, may stimulate the left atrium during the vulnerable period, thereby precipitating Atrial Fibrillation (AF).[1,2]. This case illustration will be discussed about patient who was hospitalized with diagnosis atrial fibrillation with atrial flutter episode and severe mitral stenosis
Patient was diagnosed as AF RVR with atrial flutter episode et causa suspected mitral stenosis (MS) fc III et causa suspected rheumatic heart disease (RHD) with community acquired pneumonia (CAP)

Summary

Introduction

Valvular heart disease accounts for 10% to 20% of all cardiac surgical procedures in the United States. This case illustration will be discussed about patient who was hospitalized with diagnosis atrial fibrillation with atrial flutter episode and severe mitral stenosis. Djamil General Hospital were found the atrial fibrillation rhythm with episode of atrial flutter with QRS rate about 160-170 bpm, left axis deviation, without change on ST-T segment as a figure below: On chest x-ray were found cardiomegaly with cardiothoracic ratio were 68% with prominent pulmonary segment, flattened cardiac waist with cranialization and infiltrate.

Results

Conclusion