In rheumatic heart disease, what is the typical pattern of valvular involvement over time?

• A. Mitral insufficiency acutely and stenosis later
• B. Aortic stenosis acutely and regurg later
• C. Tricuspid regurgitation
• D. Pulmonary valve stenosis

Answer: (A)

In rheumatic heart disease the valvular pattern tends to start with inflammation of the mitral valve, causing mitral regurgitation in the acute phase. Over time, repeated inflammatory episodes lead to scarring and fusion of the mitral leaflets and chordae, producing mitral stenosis as the chronic, long-term consequence. So the most typical sequence is mitral insufficiency acutely, with stenosis developing later. The aortic valve can be involved too, but the MR→MS progression is the classic pattern. This explains why patients may present initially with a regurgitant murmur and later develop symptoms and findings of mitral stenosis, such as a diastolic rumble and opening snap.