A pregnant woman at 36 weeks with known mitral stenosis (valve area 0.9 cm², moderate-severe) develops progressive breathlessness (NYHA Class III). Her heart rate is 110/min. The most appropriate initial medical management is:
- A Digoxin IV to slow the ventricular rate
- B Selective beta-blocker (metoprolol) to control heart rate and reduce filling pressure ✓
- C Percutaneous mitral balloon valvotomy (PMBV) immediately
- D Furosemide diuresis and bed rest only
Explanation
In mitral stenosis in pregnancy, elevated heart rate reduces diastolic filling time and worsens pulmonary congestion. Beta-1-selective blockers (metoprolol) are the agents of choice to control heart rate, reduce symptoms, and are safe in pregnancy (fetal monitoring required). Digoxin is used for rate control in AF but less effective in sinus tachycardia. PMBV is reserved for patients with severe MS (area <1.0–1.5 cm²) who fail medical management; it can be performed in pregnancy with radiation shielding if symptoms remain refractory. Diuretics reduce preload and are adjunctive but not the primary intervention.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.