Mitral stenosis (patient information)

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Mitral stenosis

Overview

What are the symptoms?

What are the causes?

Diagnosis

When to seek urgent medical care?

Treatment options

Where to find medical care for Mitral stenosis?

Prevention

What to expect (Outook/Prognosis)?

Possible complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Jinhui Wu, MD; Mohammed A. Sbeih, M.D. [2]

Overview

The mitral valve separates left atrium and left ventricle in the heart. Mitral stenosis refers to a condition in which the valve does not open fully, restricting blood flow. As a result, less blood flows to the body. The upper heart chamber swells as pressure builds up. Blood may flow back into the lungs. Fluid then collects in the lung tissue (pulmonary edema), making it hard to breathe. The cause of mitral stenosis are often rheumatic fever in adults. Among children, congenital or other birth defects are the main causes. Usual symptoms of mitral stenosis are fatigue, especially during times of increased activity, shortness of breath, especially with exertion or when you lie down, swollen feet or ankles, palpitations, frequent respiratory infections and heavy coughing. Echocardiogram and transesophageal echocardiogram (TEE) can tell the structure of the mitral valve and measure the mitral stenosis area. Treatments include medication, percutaneous mitral balloon valvotomy, valvuloplasty and mitral valve replacement. The prognosis of mitral stenosis varies widely. It mainly depends on the severity of mitral stenosis and heart function.

What are the symptoms of Mitral stenosis?

What causes Mitral stenosis?

Clinical data has suggested that the development of mitral stenosis is related to several factors:

Diagnosis

The health care provider will listen to the heart and lungs with a stethoscope. A distinctive 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 gets louder just before the heart begins to contract.

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

Narrowing or obstruction of the valve or swelling of the upper heart chambers may show on:

  • Echocardiogram: This kind of painless test can help the doctor closely examine the mitral valve. It uses sound waves to produce an image of the valves, ventricles and atrium. The image shows the structure of the mitral valve and its movement during the beating of the heart. Echocardiogram can tell whether mitral valve opens wide to let blood flow through or not, whether it closes fully or not. Further more, the doctor can measure the speed of blood flow through patient's heart and the mitral valve area by echocardiogram.
  • Transesophageal echocardiogram (TEE): This type of echocardiogram allows an even closer look at the mitral valve than echocardiogram. During the procedure, the doctor inserts a small transducer down the esophagus that lies close to the heart. This can provide a clearer picture of the mitral valve and blood flow through it.
  • Electrocardiogram (ECG) and Holter monitoring: Electrocardiogram and Holter monitoring can tell electric activities of the heart for cardiovascular diseases. They can supply informations about heart rhythm and indirectly, heart size. Patients with mitral valve stenosis may show a heart rhythm irregularity such as atrial fibrillation and enlarged left atrium sign.
  • Cardiac MRI (magnetic resonance imaging): Cardiac MRI can create both still and moving pictures of the valves and major blood vessels. It can help doctors analyse the structure and function of the mitral stenosis and decide the treatment protocols for the patient.
  • Chest x-ray: An X-ray image of chest allows the doctor to check the size and shape of your heart to determine whether the left atrium is enlarged. And it also helps the doctor check the condition of your lungs. Patients with mitral valve stenosis may show enlarged left atrium and congestive lungs on an X-ray.
  • Cardiac catheterization: In a catheter room, the doctor threads a thin tube through a blood vessel in your arm or groin to an artery in your heart and injects dye to see the patient's heart and the arteries on an X-ray. It can supply detailed information about the heart and the valves.

When to seek urgent medical care?

Call your health care provider if you have symptoms of mitral stenosis. Call your health care provider if your symptoms do not improve with treatment, or if new symptoms appear. If you experience either of the following symptoms, you should seek urgent medical care as soon as possible:

Treatment options

Treatment options depend on the symptoms and condition of the heart and lungs. Patients with mild symptoms or none at all may not need treatment. There are a number of different treatment options for patients with severe symptoms.

  • Medical treatment
Certain drugs can be used to reduce symptoms by easing your heart's workload and regulating your heart's rhythm:
Percutaneous mitral balloon valvotomy may be completed for patients with mild or moderate damaged mitral valves in a catheter room. During this procedure, the doctor inserts a tube into a vein and up into the heart. Then, a balloon on the tip of the catheter is inflated, widening the mitral valve and improving blood flow.
  • Surgical treatment
The purpose of the surgery is to repair or replace the damaged mitral valves and improve the symptoms that could not be controlled medically. Doctors can tell whether the patient needs surgery to treat mitral stenosis. During the procedure, the surgeons connect the patient to a heart-lung machine, which takes over the functions of the heart and lungs. Then, the surgeons can repair or replace the valve. After surgery, the patient need to take anticoagulants for a long time or the lifetime.
Mitral valve surgery can be done either by the traditional open surgery or by the minimally invasive approach:

Where to find medical care for Mitral stenosis?

Directions to Hospitals Treating Mitral stenosis

Prevention

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

What to expect (Outook/Prognosis)?

The outcome varies widely. The disorder may be mild, without symptoms, or may be more severe and eventually disabling, this depends on:

Complications may be severe or life threatening. Mitral stenosis is usually controllable with treatment and improved with valvuloplasty or surgery.

Possible complications

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000175.htm Template:WH Template:WS