Mitral stenosis history and symptoms


 * Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
After the initial episode of rheumatic fever, there is an approximate 20 year latent period before symptoms develop in mitral stenosis. Approximately half the patients will not have a recollection of having rheumatic fever. In the developed world, most patients develop symptoms between the age of 20 and 50. Initial symptoms are worsened by exercise or tachycardia. Symptoms may begin with an episode of atrial fibrillation, or may be triggered by pregnancy or other metabolic stress, such as an infection. The symptoms are initially those of left heart failure, and subsequently are those of right heart failure.

Initial Symptoms

 * Exercise intolerance
 * Dyspnea on exertion
 * Palpitations

These symptoms are exacerbated by any condition that causes tachycardia including anemia, thyrotoxicosis, fever, pregnancy (particularly in the second trimester) and the onset of atrial fibrillation as the left atrium dilates.

Mid Course Symptoms of Left Heart Failure
The above plus:
 * Chest discomfort
 * Orthopnea
 * Paroxysmal nocturnal dyspnea
 * Hoarseness due to compression of the left recurrent laryngeal nerve by the left atrium
 * Cough can be caused by compression of a bronchus by the left atrium

Later Symptoms of Right Heart Failure and Pulmonary Hypertension
The above plus:
 * Hemoptysis
 * Thromboembolism
 * Frequent respiratory infections such as bronchitis
 * Ascites and edema (if right-sided heart failure develops)
 * Fatigue, becoming tired easily

Congenital Mitral Stenosis
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
 * Dyspnea