Your Health

Mitral Stenosis -- Adult

(Mitral Valve Stenosis—Adult)

Definition

Mitral stenosis is a narrowing of the mitral valve in the heart. This valve is located between the upper chamber and the lower pumping chamber of the left side of the heart. Blood must flow from the atrium, through the mitral valve, and into the ventricle before being pumped out into the rest of the body. Mitral stenosis can result in poor blood flow between the 2 left chambers, which can affect how much blood and oxygen is getting to the body's organs and tissues.
Mitral Valve Stenosis
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Causes

The most common cause of mitral stenosis is rheumatic fever, which scars the mitral valve. Less commonly, there are some congenital heart defects which may affect the mitral valve and its function. Very rare causes include bacterial endocarditis, blood clots, tumors, or other growths that block blood flow through the mitral valve.

Risk Factors

Mitral stenosis is more common in women, and most often appears in adults between the ages of 30 and 50 years old. Other factors that may increase your chance of mitral stenosis include:

Symptoms

Mitral stenosis may cause:
  • Difficulty breathing, especially during exercise and when lying flat
  • Awakening short of breath in the middle of the night
  • Fatigue
  • Sensation of rapid or irregular heartbeat
  • Cough with exertion
  • Coughing up blood
  • Swelling of the legs or feet
  • Frequent respiratory infections
  • Lightheadedness, fainting
  • Rarely, chest pain, such as squeezing, pressure, or tightness

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may be alerted to mitral stenosis by the following:
  • Abnormal heartsounds, such as a heart murmur or snap
  • Stretching of a vein in the neck
  • Signs of fluid in the lungs
Imaging tests evaluate the heart and surrounding structures. These may include:
Your heart's electrical activity can be monitored with:

Treatment

If you have mild mitral stenosis, your condition will need to be monitored, but you may not need immediate treatment for symptoms associated with mitral stenosis. When symptoms become more severe, you may need more aggressive treatment, which may include avoiding exertion and high-salt foods.
Although no longer routinely recommended, you may need to take antibiotics prior to some dental and medical procedures. This is to prevent heart infections. Ask your doctor if you will need to take antibiotics.
Treatment may include:

Medications

Drugs may be prescribed to treat specific symptoms associated with mitral stenosis. These medications include:
  • Drugs that lower the heart rate and improve the heart's function
  • Diuretics
  • Blood-thinning drugs
  • Drugs to control heart arrhythmias
You may also need to take antibiotics when you have certain infections. This will help prevent further damage to your heart.

Surgery

Common types of heart valve surgery include:
  • Mitral valvulotomy—A surgical cut or enlargement is made in the stenotic mitral valve to relieve the obstruction.
  • Balloon valvuloplasty—A balloon device is inserted into the blocked mitral valve to open or enlarge the valve. This may provide temporary relief of symptoms. However, the valve may become blocked again.
  • Mitral valve replacement—This is the surgical replacement of a defective heart valve. This surgery is usually delayed until symptoms are severe or the patient can no longer be helped by other procedures.

Prevention

To reduce your chance of mitral stenosis or its complications:
  • Get prompt treatment for any infections, especially strep throat.
  • Talk to your doctor about prophylactic antibiotic treatment to prevent recurrent strep infections.
  • Follow any treatment plans to manage chronic health conditions.
  • Avoid excess caffeine and alcohol, and all illicit drugs that speed up your heart rate.
  • Exercise regularly and monitor your salt intake.

RESOURCES

American Heart Association http://www.heart.org

National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

The College of Family Physicians of Canada http://www.cfpc.ca

References

Infective endocarditis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 21, 2014. Accessed August 20, 2014.

Fauci AS, Braunwald E, et al. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: The McGraw-Hill Companies; 2000.

Mitral stenosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 12, 2014. Accessed August 20, 2014.

Premedication (antibiotics). American Dental Association's Mouth Healthy website. Available at: http://www.mouthhealthy.org/en/az-topics/p/Premedication-or-Antibiotics.aspx. Accessed August 20, 2014.

Shipton B and Wahba H. Valvular heart disease: review and update. Am Fam Physician. 2001;63:2201-2208.

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