A case of severe mitral valve stenosis

Could a cardiac condition be causing a woman's fatigue, cough and hoarse voice?

A 34-year-old woman who moved from the NT to tropical Queensland in her early teens attends a GP.


Over a period of six months, she has developed exertional dyspnoea, extreme fatigue, cough, wheeze and minimal haemoptysis.

She has also more recently noticed hoarseness in her voice.


The woman has pinkish-purple patches on her cheeks, which are consistent with a malar flush. Her central venous pressure is elevated to the angle of her jaw.

On auscultation, with the stethoscope bell applied to the apex of the heart in the