1. Mitral stenosis - still a challange with a myriad of features,

    Rheumatic heart disease leading to mitral stenosis is seen more often in the developing countries than in the developed world. The patients are quite asymptomatic at rest until the 2nd or 3rd decade, when they may present with various signs and symptoms like dyspnoea on exertion, palpitations, easy fatigebility, dizziness, coughing up blood, chest pain or discomfort, and swelling in legs and upto 15% of patients may present with signs of systemic emboli as a first sign like transient ischemic attack, stroke, or suddden pain in abdomen due to gut ischemia or a renal infarct. Embolic phenomenon are seen in mitral stenosis patients with atrial fibrillation, but sometimes even patients in sinus rythm may present with clinical features of sytemic emboli.

    In the above case, a young women presented with a history of parasthesia and dysarthria, for the first time. Given that she was a young Mexican lady, a high level suspicion should have been on the cardiac origin of emboli and along with CT brain to rule out stroke , a 2-D cardiac echo study would have been very useful to rule out any emboli in the left heart. The echo would have given the appropriate diagnosis and guided the proper anticoagulation therapy and a further mitral valve replacement as the final treatment. In conclusion, a young patient presenting with a TIA/stroke/hemiparesis needs a thorough assessment of the source of the systemic emboli and thus a very high level of suspicion for cardiac origin.

    Conflict of Interest:

    None declared

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