From: https://www.nlm.nih.gov/medlineplus/ency/article/000175.htm

Mitral stenosis

       

Mitral stenosis is a disorder in which the mitral valve does not fully open. This

restricts the flow of blood.

CausesBlood that flows between different chambers of your heart must flow through a

valve. The valve between the two chambers on the left side of your heart is called

the mitral valve. It opens up enough so that blood can flow from the upper chamber

of your heart (left atria) to the lower chamber (left ventricle). It then closes, keeping

blood from flowing backwards.

Mitral stenosis means that the valve cannot open enough. As a result, less blood

flows to the body. The upper heart chamber swells as pressure builds up. Blood and

fluid may then collect in the lung tissue (pulmonary edema), making it hard to

breathe.

In adults, mitral stenosis occurs most often in people who have had rheumatic fever.

This is a disease that can develop after an illness with strep throat that was not

properly treated.

The valve problems develop 5 - 10 years or more after having rheumatic fever.

Symptoms may not show up for even longer. Rheumatic fever is becoming rare in

the United States because strep infections are most often treated. This has made

mitral stenosis less common.

Rarely, other factors can cause mitral stenosis in adults. These include:

Calcium deposits forming around the mitral valve

Radiation treatment to the chest

Some medications

Children may be born with mitral stenosis (congenital) or other birth defects

involving the heart that cause mitral stenosis. Often, there are other heart defects

present along with the mitral stenosis.

Mitral stenosis may run in families.

SymptomsAdults may have not symptoms. However, symptoms may appear or get worse with

exercise or other activity that raises the heart rate. Symptoms will most often

develop between ages 20 and 50.

Symptoms may begin with an episode of atrial fibrillation (especially if it causes a

fast heart rate). Symptoms may also be triggered by pregnancy or other stress on

the body, such as infection in the heart or lungs, or other heart disorders.

Symptoms may include:

Chest discomfort that increases with activity and extends to the arm, neck, jaw or

other areas (This is rare)

Cough, possibly with bloody phlegm

Difficulty breathing during or after exercise, or when lying flat;

Waking up due to breathing problems (This is the most common symptom)

Fatigue

Frequent respiratory infections, such as bronchitis

Feeling of pounding heart beat (palpitations)

Swelling of feet or ankles

In infants and children, symptoms may be present from birth (congenital). It will

almost always develop within the first 2 years of life. Symptoms include:

Cough

Poor feeding, or sweating when feeding

Poor growth

Shortness of breath

Exams and TestsThe health care provider will listen to the heart and lungs with a stethoscope. A

murmur, snap, or other abnormal heart sound may be heard. The typical murmur is

a rumbling sound that is heard over the heart during the resting phase of the

heartbeat. The sound often gets louder just before the heart begins to contract.

The exam may also reveal an irregular heartbeat or lung congestion. Blood pressure

is most often normal.

Narrowing or blockage of the valve or swelling of the upper heart chambers may be

seen on:

Chest x-ray

CT scan of the heart

Echocardiogram

ECG (electrocardiogram)

MRI of the heart

Transesophageal echocardiogram (TEE)

TreatmentTreatment depends on the symptoms and condition of the heart and lungs. People

with mild symptoms or none at all may not need treatment. For severe symptoms,

you may need to go to the hospital for diagnosis and treatment.

Medicines which can be used to treat symptoms of heart failure, high blood pressure

and abnormal heart rhythms include:

Diuretics (water pills)

Nitrates, beta-blockers

Calcium channel blockers

ACE inhibitors

Angiotensin receptor blockers (ARBs)

Digoxin

Anticoagulants (blood thinners) are used to prevent blood clots from forming and

traveling to other parts of the body.

Antibiotics may be used in some cases of mitral stenosis. People who have had

rheumatic fever may need long-term preventive treatment with the antibiotic

penicillin.

In the past, most patients with heart valve problems were given antibiotics before

dental work or invasive procedures, such as colonoscopy. The antibiotics were given

to prevent an infection of the damaged heart valve. However, antibiotics are now

used much less often. Ask your doctor whether you need to use antibiotics.

Some people may need heart surgery or procedures to treat mitral stenosis. These

include:

Percutaneous mitral balloon valvotomy (also called valvuloplasty). During this

procedure, a tube (catheter) is inserted into a vein, usually in the leg. It is threaded

up into the heart. A balloon on the tip of the catheter is inflated, widening the mitral

valve and improving blood flow. This procedure may be tried instead of surgery in

people with a less damaged mitral valve. Even when successful, the procedure may

need to be repeated months or years later.

Surgery to repair or replace the mitral valve. Replacement valves can be made from

different materials. Some may last for decades, and others can wear out and need to

be replaced.

Children often need surgery to either repair or replace the mitral valve.

Outlook (Prognosis)The outcome varies. The disorder may be mild, without symptoms, or may be more

severe and become disabling over time. Complications may be severe or life-

threatening. In most cases, mitral stenosis can be controlled with treatment and

improved with valvuloplasty or surgery.

Possible Complications

Atrial fibrillation and atrial flutter

Blood clots to the brain (stroke), intestines, kidneys, or other areas

Congestive heart failure

Pulmonary edema

Pulmonary hypertension

When to Contact a Medical ProfessionalCall your health care provider if:

You have symptoms of mitral stenosis.

You have mitral stenosis and symptoms do not improve with treatment, or new

symptoms appear.

PreventionFollow your health care provider's recommendations for treating conditions that can

cause valve disease. Treat strep infections promptly to prevent rheumatic fever. Tell

your health care provider if you have a family history of congenital heart diseases.

Mitral stenosis itself often cannot be prevented, but complications can be prevented.

Tell your health care provider about your heart valve disease before you receive any

medical treatment. Discuss whether you need preventive antibiotics.

Alternative NamesMitral valve obstruction

ReferencesNishimura. RA, Otto CM, Bownow RO et al. 2014 AHA/ACC Guideline for the

Management of Patients With Valvular Heart Disease: A report of the American

College of Cardiology/American Heart Association Task Force on Practice GuidelinesJ

Thorac Cardiovasc Surg.

Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds.Goldman's Cecil

Medicine

Wilson w, Taubert KA, Gerwitz M, et al. Prevention of infective endocarditis:

guidelines from the American Heart Association: a guideline from the American Heart

Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee,

Council on Cardiovascular Disease in the Young, and the Council on Clinical

Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of

Care and Outcomes Research Interdisciplinary Working Group.Circulation.

Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby

P, Braunwald E, eds.Braunwald's Heart Disease: A Textbook of Cardiovascular

Medicine.

Update Date 5/13/2014Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of

Cardiology, Harborview Medical Center, University of Washington Medical School,

Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the

A.D.A.M. Editorial team.