SHM Converge Scientific Abstract ePoster Gallery-Forgotten Cause of New Onset Atrial Fibrillation

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A 49-year-old woman of German ancestry with no prior medical history presented with 2 weeks of shortness of breath and right leg symptoms. On exam, she was tachycardic with a loud systolic murmur at the cardiac apex. Workup showed mild leukocytosis, elevated D-dimer and BNP, mild transaminitis, and atrial fibrillation with rapid ventricular response. Chest imaging revealed pulmonary vascular congestion and a small right lung nodule, but no pulmonary embolism. Transthoracic echocardiography demonstrated preserved ejection fraction (60–65%) with mild right ventricular dysfunction and severe rheumatic-appearing mitral stenosis, with mitral valve area reduced to 1.4 cm².<br /><br />She was treated with warfarin for anticoagulation, diltiazem for rate control, and diuresis, with clinical improvement. Cardiac catheterization later showed 70% stenosis of the obtuse marginal artery, and she underwent coronary artery bypass grafting, mechanical mitral valve replacement, and left atrial appendage excision.<br /><br />The report emphasizes that rheumatic heart disease is a long-term complication of acute rheumatic fever and most often affects the mitral valve. Although its incidence has declined in the United States and many patients do not have a recognized history of acute rheumatic fever, it should remain in the differential diagnosis for new-onset heart failure or atrial fibrillation. Because the disease progresses slowly, patients may first present with complications such as atrial fibrillation, heart failure, or embolic stroke. Echocardiography is key for diagnosis and severity assessment. In patients with rheumatic heart disease and atrial fibrillation, vitamin K antagonists are the studied anticoagulants shown to reduce embolic risk. The case highlights the need to consider rheumatic heart disease even without a known history of acute rheumatic fever.

Asset Subtitle

Himal Chapagain

Meta Tag

Author List Cynthia C. Omenyi, Himal Chapagain, Jonathan Arnold

Category Clinical Vignettes

Concept Rheumatic Heart Disease

Concept Atrial Fibrillation

Concept Mitral Stenosis

Concept Heart Failure

Concept Rheumatic Mitral Valve Disease

Distinguished Non-Finalist

Presenter Organization University of Pittsburgh Medical Center, McKeesport

Presenting Author Himal Chapagain

Track Adult

Keywords

rheumatic heart disease

mitral stenosis

atrial fibrillation

heart failure

echocardiography

mitral valve replacement

warfarin anticoagulation

acute rheumatic fever

coronary artery bypass grafting

embolic risk

Rheumatic Heart Disease

Atrial Fibrillation

Mitral Stenosis

Heart Failure

Rheumatic Mitral Valve Disease