Mitral stenosis (patient information)

For the WikiDoc page for this topic, click here


 * Associate Editor-in-Chief: Jinhui Wu, MD; Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

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. In 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?
In adults there may be no symptoms at all. Symptoms may appear or get worse with exercise or any activity that raises the heart rate. Symptoms may include:


 * Chest discomfort: Patients may feel tight, crushing, pressure, squeezing, constricting, increasing with activity and decreasing with rest. The pain may radiate to the arm, neck, jaw, or other areas.
 * Cough, possibly hemoptysis.
 * Difficulty breathing during or after exercise or when lying flat.
 * Fatigue.
 * Frequent respiratory infections such as bronchitis.
 * Palpitations.
 * Swelling of feet or ankles.

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

In infants and children, symptoms may be present from birth (congenital), and almost always develop within the first 2 years of life. Symptoms include:


 * Bluish discoloration of the skin or mucus membranes (cyanosis).
 * Poor growth.
 * Shortness of breath.

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


 * A history of rheumatic fever and recurrent strep infections. The valve problems develop 5 - 10 years after the rheumatic fever. Rheumatic fever is becoming rare in the United States, so mitral stenosis is also less common.
 * Radiation treatment involving the chest.
 * Medications such as ergot preparations used for migraines.
 * Rarely, there maybe calcium deposits forming around the mitral valve and cause mitral stenosis in adults.
 * 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.

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 close 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 you have mitral stenosis and 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:
 * Hemoptysis.
 * Difficulty breathing when lying flat; may wake up with difficulty breathing.
 * Palpitation.

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.

Certain drugs can be used to reduce symptoms by easing your heart's workload and regulating your heart's rhythm:
 * Medical treatment
 * Antibiotics: Antibiotics may be recommend before certain dental or medical procedures to reduce the risk of bacteria entering your bloodstream and causing an infection in your heart (endocarditis).
 * Diuretics: Diuretics can be used to control pulmonary edema. There are three kinds of diuretics, loop diuretics, thiazides and potassium-sparing diuretics. The patients should take the medicines under the doctor's direction and check the blood level of electrolyes regularly.
 * Beta-blockers, digoxin and antiarrhythmic agents: These drugs can be used to control heart rate, maintain normal sinus rhythm and treat arrhythmia.
 * Anticoagulants: Anticoagulants are used to prevent blood clots from forming and traveling to other parts of the body.

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.
 * Percutaneous mitral balloon valvotomy

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.
 * Surgical treatment

Mitral valve surgery can be done either by the traditional open surgery or by the minimally invasive approach:


 * Mitral valve surgery - open


 * Mitral valve surgery - minimally invasive

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.


 * Follow the health care provider's recommended treatment for conditions that may 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.

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:


 * The severity of mitral stenosis, such as mitral valve area.
 * Heart function
 * With/without complications such as atrial fibrillation, atrial flutter, blood clots to the brain, intestines, kidneys, or other areas, heart failure, pulmonary edema, pulmonary hypertension, etc.
 * Whether or not the mitral can be repaired or replaced by surgery.

Complications may be severe or life threatening. Mitral stenosis is usually controllable 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.
 * Heart failure.
 * Pulmonary edema.
 * Pulmonary hypertension.