This handout is for mitral stenosis (rheumatic + degenerative). Your care team identified this based on: progressive dyspnea on exertion / orthopnea / pnd (acc/aha 2020 vhd stage d symptom).
Other reasons your team may use this plan: hemoptysis — bronchial vein rupture from elevated la pressure (acc/aha 2020 vhd); palpitations or new af (acc/aha 2020 — af nearly universal in moderate-severe ms); opening snap + low-pitched diastolic rumble at apex (acc/aha 2020 vhd).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| metoprolol_succinate | 25–50 mg | PO | once daily | Lengthen diastole — ACC/AHA 2020 VHD Class I; AVOID HR <50 |
| atenolol | 25–50 mg | PO | once daily | Pregnancy: avoid atenolol — use metoprolol/labetalol if pregnant (ESC 2021 VHD) |
| diltiazem | 120–360 mg/day | PO | daily / divided | Alternative AVN slowing (ACC/AHA 2020 VHD); avoid if EF <40% |
| verapamil | 120–480 mg/day | PO | daily / divided | Alternative AVN slowing (ACC/AHA 2020 VHD); avoid if EF <40% |
| digoxin | 0.125–0.25 mg | PO | daily | Adjunctive AVN slowing (ACC/AHA 2020 VHD); renal dosing required |
| furosemide | 20–40 mg | PO/IV | once daily / BID | Decongestion; symptom relief; NOT valve-modifying (ACC/AHA 2020 VHD Class I) |
| torsemide | 10–20 mg | PO | daily | Better PO bioavailability vs furosemide (ACC/AHA 2020 VHD) |
Plan: Rate control + decongestion in MS (ACC/AHA 2022)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiology q3-12 mo (ACC/AHA 2020); high-volume valve surgeon if intervention (ESC 2021 — heart valve centre); OB-cardio team in pregnancy
Guideline: 2020 AHA/ACC VHD (Otto/Nishimura) + 2023 focused update; ESC/EACTS 2021 VHD; INVICTUS NEJM 2022