EFFECT OF HEART RATE ON HEMODYNAMICS IN MITRAL STENOSIS

Abstract

Objective: To assess the effect of heart rate (HR) on haemodynamic parameters
in patients with Mitral Stenosis (MS).
Methodology: The study was conducted at Cardiology department, Lady
Reading Hospital, Peshawar from November 2010 to April 2011. Patients with
MS, regardless of severity, were included. Patients with severe heart failure, other
valvular or structural heart disease were excluded. Echocardiographic
parameters were recorded at slow and fast HR. Patients with tachycardia were
given β-blockers and patients with bradycardia were given parenteral Atropine.
Results: A total of 60 patients were included, females were 57 (78%). Mean age
was 31± 9 years. Mean slow and fast HR was 77±12bpm and110±13 bpm,
respectively. Peak mitral valve gradient (PMVG) slow vs. fast HR was 12.8±4.80
and 14.93±7.18 mm Hg (p=0.000). Mean mitral valve gradient (MMVG) at slow
vs. fast HR was 6.62±3.29 and 8.15±4.88 mm of Hg (p=0.000). E pulse
Doppler (E) at slow vs. fast HR was 168±35 and 181±40 cm/s (p=0.013),
/ while E tissue Doppler (E ) velocity was 10.47±2.81 and 10.97±2.38 cm/s
/ (P=0.098), respectively. E/E ratio for slow and fast HR was 17±5.63 vs.
17±5.41 (P=0.792). Right ventricular systolic pressure (RVSP) at slow vs. fast
HR was44±16 vs.49±17.05mm of Hg (P=0.001). The above parameters had
insignificant change with the HR when there was accompanying more than mild
MR.
Conclusion: Slowing HR in patients with MS significantly decreased PMVG,
MMVG and RVSP. LV function did not change significantly with HR. Rate control
drugs may be used in preference to improve symptoms in moderate and severe
MS