Rheumatic heart disease
The PA chest x-ray shows marked enlargement of the cardiac silhouette. There is a \"double density\" and splaying of the carina c/w left atrial enlargement .There is enlargement of the main pulmonary artery due to pulmonary arterial hypertension.
Rheumatic heart disease has a number of classic radiographic findings, including the \"double density\" of the enlarged left atrium, the splaying of the mainstem bronchus, and posterior displacement of the left lower lobe bronchus and left atrial enlargement on the lateral film. Left atrial appendage enlargement is felt to be highly suggestive of mitral stenosis secondary to rheumatic heart disease.
Rheumatic disease causes mitral stenosis in 99.8% of cases
Effect of MS on Heart
- Left atrium hypertrophies and dilates 2° pressure and volume load
- Atrial fibrillation and mural thrombosis follow
- Left ventricle is “protected†by stenotic valve
- Usually normal in size and contour
Effect of MS on Lungs
- Increased pulmonary venous and capillary pressure
- Chronic edema of alveolar walls → fibrosis
- Pulmonary hemosiderin is deposited in lungs
- Pulmonary ossification may occur Effect of MS on Lungs
- Pulmonary arterial hypertension develops
- First passively
- Then 2° muscular hypertrophy and hyperplasia → increased pulmonary vascular resistance
Effect of MS on Right Ventricle
- RV hypertrophies in response to increased afterload
- Eventually RV fails and dilates
- Causes dilation of tricuspid annulus → tricuspid regurgitation