Definition:
Mitral stenosis is a valve disease in which the mitral valve is abnormal such that blood flow from the left atrium to the left ventricle is restricted. This causes the left atrium to increase its pressure workload to adequately send blood to the left ventricle, and subsequently this pressure overload is referred to the lungs, causing congestion in the lung vessels. Also, the right ventricle is responsible for filling the left side of the heart, and this restriction and congestion may cause the right ventricle to eventually fail. Usually, the cause of mitral stenosis is from rheumatic heart disease, with patients having a history of rheumatic fever. Usually more common in females for unknown reasons.
Symptoms:
- Shortness of breath - on exertion, lying flat, and/or waking up [left-sided heart failure]
- Fluid retention - edema (swelling in legs) and ascites (fluid in abdomen) [right-sided heart failure]
- Fatigue
- Hemoptysis - coughing up blood
- Hoarseness
- Systemic embolization - thrombus/clot forming in left atrium because of congestion
- Neck vein distension
Diagnosis:
- Physical Exam - opening snap/diastolic rumble murmur heard on stethoscope
- EKG - to evaluate heart rhythm, may show atrial fibrillation, left atrial enlargement, and right ventricle hypertrophy
- Chest X-Ray - to evaluate pulmonary congestion and heart size
- Echocardiography - to evaluate mitral valve and ventricle function
- Cardiac catheterization - to evaluate pressure gradient across mitral valve
Treatment:
- Medications - diuretics (to limit shortness of breath), digitalis (for patients with atrial fibrillation), beta-blockers/verapamil (for atrial fibrillation), anticoagulants (to prevent thrombus formation)
- Balloon valvuloplasty - can be used for long-term relief of mitral stenosis
- Mitral commissurotomy - for patients without severe calcium deposits on valve
- Mitral valve replacement - with severe diseases and if other options have failed
