Mitral Stenosis: From

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.
Causes
Blood 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.
Symptoms
Adults 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 Tests

The 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)
Treatment
Treatment 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 lifethreatening. 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 Professional

Call 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.
Prevention
Follow 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 Names
Mitral valve obstruction
References
Nishimura. 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 5/13/2014

Updated 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.

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

Calcium deposits forming around the mitral valve

Radiation treatment to the chest

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)

Frequent respiratory infections, such as bronchitis

Feeling of pounding heart beat (palpitations)

Swelling of feet or ankles

Poor feeding, or sweating when feeding

Exams and Tests

CT scan of the heart

MRI of the heart

Transesophageal echocardiogram (TEE)

Diuretics (water pills)

Calcium channel blockers

Angiotensin receptor blockers (ARBs)

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

Atrial fibrillation and atrial flutter

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

Congestive heart failure

When to Contact a Medical Professional

You have symptoms of mitral stenosis.

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

Update Date 5/13/2014

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