Rheumatic mitral stenosis is a chronic cardiac lesion that remains after acute rheumatic fever invades the heart and is still quite common in China. Rheumatic heart valve disease is most common in mitral valve, followed by aortic valve, tricuspid valve is rare, and pulmonary valve is even rarer. Chronic rheumatic heart disease can involve several valves. The most common is mitral valve lesion alone, accounting for about 70%, followed by mitral valve combined with aortic valve lesion accounting for about 25%, aortic valve lesion alone accounting for about 2-3%, tricuspid valve or pulmonary valve lesion is mostly combined with mitral valve or aortic valve lesion. Rheumatic fever mostly develops in adolescence and is a metabolic disease. The lesions attack the collagen fibers of the connective tissue, producing mucinous and fibrinoid changes, with progressive fibroblast proliferation and lymphocyte and monocyte infiltration forming rheumatoid vesicles. What tests should be done for mitral stenosis 1, echocardiography (UCG) UCG has a high specificity for the diagnosis of mitral stenosis. 2.X-ray examination The x-ray findings are related to the degree of mitral stenosis and the stage of disease development. In mild mitral stenosis, the heart shadow may be normal. In moderate stenosis or above, the examination may reveal enlarged left atrium, prominent pulmonary artery segment, elevated left bronchus, and enlarged right ventricle. In the posterior-anterior position, the heart shadow is pear-shaped, called “mitral heart”, and the aortic node is slightly smaller. The pulmonary manifestation of mitral stenosis is mainly pulmonary stasis with marked deepening of hilar shadow. Due to redistribution of pulmonary venous blood flow, there is often an increase in vascular shadow in the upper part of the lung and a decrease in the lower part. The pulmonary lymphatics are dilated, and a horizontal line shadow, known as the Kerley B line, is commonly seen in the right outer lower lung field and near the angle of the rib diaphragm on posterior anterior and left anterior oblique chest films. Occasionally, a linear shadow running obliquely from the upper lobe of the lung toward the hilum is seen, called Kerley A line. In addition, as a result of prolonged pulmonary stasis, punctate shadows with iron-containing heme deposits are seen in the lung fields. 3.Electrocardiogram Mild mitral stenosis, the electrocardiogram may be normal. In moderate and severe mitral stenosis, the earliest ECG changes are the characteristic enlarged P waves in the left atrium, i.e., widened and bimodal P waves, which are called mitral P waves (P II > 0.12s, V1Ptf < -0.3 mm・s, p axis +45°～-30°). As the disease progresses, when the combined pulmonary hypertension involves the right heart, there may be electrocardiographic manifestations of right deviation of the electrical axis and right ventricular hypertrophy. Arrhythmias are very common in patients with mitral stenosis and may manifest as atrial prophase contractions in the early stages. Frequent and multiple atrial prophase contractions are often the precursors of atrial fibrillation, and atrial fibrillation often occurs when the left atrium is significantly enlarged. 4.Cardiac catheterization For rare cases with diagnostic difficulties, cardiac catheterization should be considered. The main manifestations of cardiac catheterization are increased pressure in the right ventricle, pulmonary artery and small pulmonary artery, increased resistance to pulmonary circulation, and decreased cardiac output. Transatrial septal puncture allows direct measurement of left atrial and left ventricular pressures and trans-micronomic valve pressure difference. Complications 1. Arrhythmias: Atrial arrhythmias are most common, starting with atrial premature beats, followed by atrial tachycardia, atrial flutter, paroxysmal atrial fibrillation until persistent atrial fibrillation. Enlargement of the left atrium due to increased left atrial pressure and fibrosis of the left atrial wall due to rheumatic inflammation are the pathological basis for the persistence of atrial fibrillation. Atrial fibrillation decreases cardiac blood output and can precipitate or exacerbate heart failure. After the appearance of atrial fibrillation, the presystolic enhancement of the diastolic rumble in the apical region may disappear, and the diastolic rumble in the apical region may be reduced or disappear in rapid atrial fibrillation, and then be obvious or appear when the heart rate slows down. 2, congestive heart failure and acute pulmonary edema: congestive heart failure occurs in 50% to 75% of patients and is the leading cause of death in mitral stenosis. Respiratory infections are a common cause of heart failure, and pregnancy and childbirth are also frequent triggers of heart failure in female patients. Acute pulmonary edema is an acute complication of severe mitral stenosis and occurs with strenuous physical activity, emotional stress, infection, sudden tachycardia or rapid atrial fibrillation, and is more likely to be induced during pregnancy and childbirth. alveoli, thus causing acute pulmonary edema. 3, embolism: cerebral embolism is the most common, but also occurs in the extremities, intestines, kidneys and spleen and other organs, emboli are mostly from the enlarged left atrium with atrial fibrillation. Emboli from the right atrial source can cause pulmonary embolism or pulmonary infarction. 4, pulmonary infection: patients with this disease often have increased pulmonary venous pressure and pulmonary stasis, easy to combine pulmonary infection. The presence of broad lung infection often aggravates or induces heart failure. 5. Subacute infective endocarditis is less common. Arrhythmias are very common in patients with mitral stenosis and may manifest as atrial prophase contractions in the early stages. Frequent and multiple sources of atrial prophase contractions are often precursors to atrial fibrillation, and atrial fibrillation often occurs when the left atrium is significantly enlarged.