skip to main content

Rheumatic Mitral Stenosis — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyCardiologyRheumatic Mitral StenosisRACP Adult Medicine

A 60-year-old woman with a history of rheumatic fever presents with progressive dyspnoea and haemoptysis. Echocardiography shows severe mitral stenosis with a valve area of 0.9 cm² and she is in atrial fibrillation. She is commenced on anticoagulation. What is the preferred anticoagulant?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Warfarin

Rheumatic mitral stenosis is a specific indication where warfarin remains the only recommended anticoagulant. DOACs are NOT recommended for valvular AF due to rheumatic mitral stenosis (as per the 2025 Australian ACS guideline and 2018 Australian AF guidelines). The INVICTUS trial confirmed that rivaroxaban was inferior to warfarin in rheumatic heart disease patients.

Reference: NHF/CSANZ – 2018 – AF Guidelines; 2025 – ACS Guideline