What is the primary medical therapy for controlling heart rate in patients with Mitral Stenosis?

In patients with mitral stenosis, controlling heart rate is crucial to managing symptoms and preventing complications, primarily atrial fibrillation. In this context, beta-blockers and calcium channel blockers are the preferred therapies.

Beta-blockers work by decreasing heart rate and improving myocardial oxygen consumption while also providing rate control, especially in the presence of atrial fibrillation. These agents are effective in managing symptoms associated with the increased heart rate that can occur due to the reduced ability of the heart to fill properly due to the stenosis.

Calcium channel blockers, specifically the non-dihydropyridine types like verapamil and diltiazem, are also effective for rate control. They help to slow down conduction through the AV node and decrease heart rate. This can be particularly beneficial in patients with atrial fibrillation as well.

While diuretics may alleviate symptoms of fluid overload in mitral stenosis by reducing blood volume and venous return, they do not directly control heart rate. ACE inhibitors can help with long-term management of heart failure symptoms but are not indicated for acute heart rate control. Nitrates are typically used for angina relief and do not target heart rate control in the context of mitral stenosis.

Thus,